Don't wait to anti-coagulate

The health challenge in the North West Coast

·   Identification: The North West Coast has a higher than average number of strokes caused by Atrial Fibrillation (AF). There are currently around 220 strokes in the region each year caused by non-identified AF.  Atrial fibrillation is a heart condition that causes an irregular heartbeat or flutter. AF increases the risk of having a stroke – a risk that can be reduced by anticoagulant medicines. But although evidence has shown that AF strokes are more likely to result in serious strokes and long-term harm, the National Institute for Health and Care Excellence estimates that 46% of high-risk AF patients are not currently anti-coagulated.

·   Management: Approximately 20% of people are not receiving anti-coagulation medication and could be managed better.

·   Monitoring: Some people are anti-coagulated poorly (not in line with NICE guidance). People with AF should be kept in therapeutic range for at least 65% of the time.

Our response

The Innovation Agency’s North West Coast AF Collaborative works with a range of partners including pharma companies, charities and CCGs to increase the use of anti-coagulation medicine and improve the management of atrial fibrillation patients. 

We are working with CCGs and individual GP practices to identify changes that will result in an improvement in the care of people with AF. Our programme includes a first wave of over 50 GP practices and we are adding another wave of practices and CCGs during 2017.

Our programme is based on the West of England programme - 'Don't wait to anti-coagulate' which includes key elements such as quality improvement, training and local clinical leadership.

You can download a flyer about the AF Collaborative here.

Our aims

·         Decrease the prevalence gap between expected and actual AF patients 

·         Improve medicines optimisation and anti-coagulation 

·         Improve outcomes for people with AF in reducing preventable strokes

·         Employ innovative technologies to help us do this


AF collaborative practices will receive a bespoke improvement and innovation support package, facilitated by the Innovation Agency.




North West Coast Commissioning tool-kit and pathway

The Innovation Agency worked with the Strategic Clinical Network and clinicians to develop a commissioning toolkit for the treatment of AF which could potentially save 600 strokes in our region per year – saving £13.8m.

Clinical pathway to managing AF

Please download this practical guide which is designed to support providers and NHS commissioners with improving clinical practice for people with or at risk of AF.

North West Coast AF dashboard

We have worked with our colleagues in Greater Manchester AHSN to produce a dashboard of a range of tools associated with the measurement of AF. The dashboard includes data from NHS Digital (QoF, HES, SSNAP) Rightcare (NCVIN), Prescribing, GRASP-AF and therapeutic effectiveness data. More details can be found from

Genotype guided dosing for warfarin

Research has shown that a genotype-guided dosing can improve the establishment of the warfarin dose and ensure that patients are effectively anti-coagulated quicker. Our region has been the first in the UK to deploy this technology. You can read more here.

Self-monitoring of patients on warfarin

Evidence from NICE and other authoritative sources indicates that patients who self-monitor using devices such as the Coaguchek, are able to stay within their therapeutic range more effectively. We have supported the introduction of self-monitoring in East Lancashire and will continue the roll-out of this programme in 2017.

Know Your Pulse

You can wiew a presentation by Julia Reynolds about the Lancashire ‘Know your pulse’ campaign here

'Starting Anticoagulation with Jack'

Wessex AHSN has created a new video - 'Starting Anticoagulation with Jack' which explains about clotting and why abnormal clots can form as people age.  The video has been created to prevent people becoming unwell while on anticoagulant medicines and avoid unnecessary hospital admissions.




If you work in primary care and would like to get involved in this project, or would like more information please contact:

Dr Julia Reynolds - Programme Lead