Presentation on theme: "THE NATIONAL ANTICOAGULATION INITIATIVE"— Presentation transcript:
1 THE NATIONAL ANTICOAGULATION INITIATIVE Dr Andy HughesConsultant Community HaematologistSouth West Essex Community ServicesandNorth East London Foundation Trust
2 ~ 12,500 AF-related strokes/year in the UK High economic cost ~£600 million direct cost to NHS£800+million in “indirect” costsIncidence of AF set to double from one to two million by 2050
3 AF related strokes are bad! 25% mortality at 30 days.Significant disability.“A fate worse than death” burden on:CarersFamilySocietyHealth & social services
4 AF also associated with Increased incidence of silent cerebral infarcts15% in AF patients with no prior h/o strokeEzekowitz et al Circulation. 92(8):2178.Increased incidence of dementiaBunch et al Heart Rhythm. 7(4):433.
5 AF STROKES ARE PREVENTABLE 65% reduction in stroke20% reduction in strokeSimilar bleeding risk to Warfarin
6 GRASP-AF Guidance on Risk Assessment and Stroke Prevention for AF TotalPatientswith AFwith C2>2C2 >2 onOACC2 >2 not onASAC2 >2No anti-thromboticB/Wood- total76,5111,48091153238129388- %1.9%61.5%58%42%32%10%National data*1.77%57.5%56%43.6%35%8.7%*as of Jan 2013C2 = CHADS2 scoreOAC = oral anticoagulantASA = Aspirin2 main risk factors with C2HypertensionAge >75
7 WHAT’S MORE…..Patients with AF & a previous stroke admitted with 2nd stroke57% on a VKA.Of these only1/3rd have therapeutic INRs.25% are only on an antiplatelet agent.15% are not on any anti-thrombotic.
8 Key issues in commissioning anticoagulation therapy NICE May 2013. Variation in the quality and safety of anticoagulation therapy across the countryVariation across the country in the activities of anticoagulation services, because there is no standard service model or definition of an anticoagulation serviceA large proportion of people with AF are currently not receiving anticoagulation therapy in line with NICE guidance.
9 NATIONAL ANTICOAGULATION INITIATIVE CREATING A SYSTEM OF CARESYSTEMDefines the outcome to be delivered to patientsNETWORKDetermines who delivers care to the patientsPATHWAYDescribes how the care is delivered
10 The National Anticoagulation Initiative System Common aim – stroke reduction in individuals with AFShared:ObjectivesCriteriaStandardsIndividual local service pathwaysAnnual report on a standardised template published on The Initiatives website**
11 OBJECTIVESPromote stroke risk assessment of all known AF patients using CHADS2 (or CHADS-VASc).Increase the percentage of patients with CHADS2 scores of >2 on an OAC.Decrease the percentage of patients on APT.Measure the efficacy and safety of anticoagulation provided:Clinic TTRPercentage of patients with a TTR of >60%Critical INRs (<1.5 and >5.0)Adverse events (bleeding or thrombosis)
12 ADDITIONAL OBJECTIVES 1/3rd of individuals with AF are asymptomaticCase finding with opportunistic pulse taking (“Just a minute”)Service IntegrationAF
13 The National Initiative in Brentwood Nurse-led anticoagulant clinic~850 active patientsNine practicesPopulation ~76,000~1500 known AF patients
14 “Houston, we have a problem…” Doctors fear bleeding:Patients not put onto Warfarin.Undertreated.EDUCATIONPatients fear stroke.
15 Education, education, education……… Educating colleagues and patients about AF is not just about sharing knowledge but about changing behaviour.“Knowledge is the enemy of disease.”
16 How can we drive this forward? Initiative in preventing stroke & vascular dementiaThe National Anticoagulation Initiative is part of one of the working themesPublic Health can be an important driver of:CCGsGPsSupport of PHE will be important for the success of The Initiative.NHS Health Check implementation review and action planJuly 2013
17 THE NATIONAL INITIATIVE Brought together a group of innovators from different parts of the countryShared aim and agreed objectivesPromote best practiceSimple measurements of success, quality and safetyScalable national anticoagulation and stroke prevention programmeAim for national coverage within 5 yearsReduce the high economic cost of AF-related strokeReduce the burden on carers, family, societyReduce the demands on health and social services