Background: Annually in England there are 89,000 strokes. 18% of patients presenting with stroke are in AF at presentation, equating to some 16,000 strokes, of which 12,500 are thought to be directly attributable to AF. Objectives: Reduce the number of AF related strokes by optimal anticoagulation according to NICE CG 180. Provide education and support to GP practices around identification of patients with AF as well as appropriate anticoagulation. Methods: In this analysis, a total of 5 GP practices ran the Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) audit tool to identify patients diagnosed with AF. An AF nurse specialist reviewed each patient to ensure that they are on optimal anticoagulation based on clinical characteristics and NICE CG 180. Results: A total of 374 patients have been reviewed with an average age of 77 and an equal proportion of males. The majority of patients are diagnosed with permanent AF (54%); have a CHA2DS2-VASc score between 3 and 5 (3: 18%, 4: 20%, and 5: 22%) and a HAS-BLED score of 2 (48%). The number of patients prescribed aspirin and clopidogrel has been reduced from 26% and 6%, to 8% and 3%, respectively. In addition, the number of patients treated with non-vitamin K antagonist oral anticoagulants (NOACs increased from 2% to 19% after treatment review. Patient satisfaction survey results revealed that patients are happy with the service and felt at ease discussing treatment options. Conclusions: Overall, 34% of patients received a revised treatment regimen based on NICE CG 180. The results indicate that despite not being recommended in NICE CG 180, a high proportion of AF patients are currently managed with antiplatelet instead of anticoagulation. In addition, a nurse specialist service redesign has the potential to optimise AF anticoagulation services, providing longterm reductions of AF-related strokes.
Daacke, I., Hau, N., Williams, J., & Natarajan, I. (2015). Atrial Fibrillation And Anti-Coagulation Service Run By A Clinical Nurse Specialist. Value in Health, 18(7), A400. https://doi.org/10.1016/j.jval.2015.09.921