AF and stroke prevention in the North West Coast

SUMMARY

Our ongoing work to identify atrial fibrillation (AF) has led to more than 500 potential stokes being avoided, saving around £11.2m in NHS resources, from 2014 to early 2018.

We estimate we are screening around 1,200 people in our region each month, which equates to about 90 patients being identified with AF, preventing a predicted three strokes per month.

To date, we estimate we have enabled around 20,000 screenings.

WHY IS THIS IMPORTANT?

Atrial fibrillation is a condition which is under diagnosed and undertreated in the North West Coast. We estimate that in our region there are over 20,000 people who have the condition but are either not identified or not well managed on treatment - as many as 40 per cent may not be managed according to NICE guidelines. Subsequently, we have some of the highest AF related stroke rates in the country, many of which could be avoided.

Each stroke costs around £24,000 to the NHS and social care in the first year alone. AF related strokes are more severe and have higher mortality and morbidity than other types of stroke; yet AF is highly amenable to treatment and has been identified by Public Health England as offering a good opportunity to improve treatment and avoid strokes.

ACTIONS TAKEN

We have:

• Run public awareness campaigns about the importance of pulse testing
• Introduced portable ECG devices to a number of health and care settings
• Provided mobile ECG devices to Cheshire Fire and Rescue Service as part of their Safe and Well visits to vulnerable residents.
• Worked with the Strategic Clinical Network to support the development of the AF pathway and the commissioning tool-kit
• Worked with Health Innovation Manchester to develop a dashboard which brings together AF related data to support CCGs with business planning
• Worked with NIHR CLAHRC NWC to roll out genotype guided dosing of warfarin
• Provided patients in East Lancashire with home monitoring technology to carry out blood tests and send results via an app and digital health systems to health professionals
• Developed a North West Coast AF Collaborative with 71 GP practices which have been given detection devices and quality improvement support for managing their patients
• Recruited more than 35 volunteer AF Ambassadors to carry out pulse tests with families, friends, colleagues and other networks

IMPACTS

We have:

• Introduced technology to patients, healthcare professionals and volunteers
• Provided training and quality improvement support to GPs
• Prevented an estimated 500 strokes
• Saved a potential £3m per year in health and care costs
• Secured more than £300,000 investment from industry
• Established more than 25 new partnerships to support the programme

PLANS FOR THE FUTURE

• Expanding the AF Collaborative to include more GP practices in more CCGs
• Supporting the development of the AF pathway
• Expanding our cohort of AF Ambassadors
• Establishing new partnerships, eg. with housing associations and other fire and rescue services
• Improving the uptake of technology which supports patients

Contact for further information

Programme Lead Dr Julia Reynolds
julia.reynolds@innovationagencynwc.nhs.uk
01772 520263
www.innovationagencynwc.nhs.uk
@innovationnwc
June 2018