Managing atrial fibrillation in primary care
The problem with AF
Atrial Fibrillation (AF) leads to an increased risk of stroke, heart failure, vascular dementia, hospitalisations, and in some cases death. The most common symptoms are palpitations, breathlessness, dizziness and syncope. However, as many as 25-30% sufferers do not have symptoms. This means that many patients fail to present for treatment, despite having a greatly elevated risk of stroke.
Within the UK, it is a condition that is not always managed well. Patients have reported poor explanations of their condition and treatment options.
The call for change in AF management
AF related strokes are debilitating. Those affected are less likely to get back to independent living and many are less likely to survive. Audits across the UK confirm that the use of anticoagulation to reduce the risk of AF related stroke is not utilised.
The management of AF in UK primary care presents a resource challenge, mainly through referrals and hospital admissions. This is set to rise as our population ages. However it is possible to identify potential efficiencies, if strategies to address these issues are incorporated into planning and policy development.
AF and Stroke - we can do better
It's clear that more needs to be done to improve the detection and management of Atrial Fibrillation in the UK. So the BHF, Public Health England, AF Association and the Stroke Association formed a partnership to combine our specialist knowledge. Together we held the AF and Stroke: we can do better conference on 24 September 2015. You can revisit the shared learning, and download all the posters and presentations from the event.
What we did
You can now download our new CPD accredited Managing Atrial Fibrillation in Primary Care summary booklet, which addresses the key issues around AF management for primary care practitioners, managers and commissioners of services. It includes the proposal, an outline of the challenges facing healthcare professionals caring for people with AF and information around education & up-skilling.
Providing integrated care
AF is a long term condition. Having integrated care would help to ensure that patient pathways are seamless, safe and person centred. We recently funded and externally evaluated nine Integrated Care Projects including two projects which incorporate the management of AF. Both projects were funded for 2 years for two 0.5wte specialist nurses.
NHS Tayside Project
There were three strands around arrhythmia care; one included establishing rapid access AF clinics across the Health Board. This project has successfully been implemented, operating at full capacity and now sustained by the NHS Health Board.
NHS Lanarkshire Project
The project involved audit and education for primary care clinicians as well as education for secondary care specialist nurses. After one year, it showed an increase in the prescribing of anticoagulants and an expected reduction of 70 AF related strokes, which is a reduction of 14% from baseline. You can read more about the management of the project and its findings in our NHS Lanarkshire case study.