1 GRASP-AF Audit - Intro 8 th July 2010 Mark Gregory
2 Workshop Objectives Phase 1 practices Overview of GRASP-AF audit Familiarity in running audit software Practice pharmacists reviews Audit timescales eg. data uploads
3 What is Atrial Fibrillation ? AF is an atrial tachyarrhythmia characterised by predominantly uncoordinated atrial activation and consequent deterioration of atrial mechanical function. On ECG, there is an absence of consistent P waves; instead there are rapid oscillations or fibrillatory waves that vary in size, shape and timing.
4 Atrial Fibrillation (AF) Irregular heartbeat (arrhythmia) Heart rate often faster than normal Force of heartbeat variable intensity Symptoms: palpitations, dizziness, angina, breathlessness Or no symptoms!
5 AF Classification Paroxysmal Persistant Permanent AF management pathways
6 Prevalence of AF Local pilot audits: from 1.2% (ie. 12 per 1K patients) to 2.6% (ie. 26 per 1K patients) Aged 50-60 yrs: 1 in 200 people Aged > 80: 1 in 10 people
7 Key complication - Stroke Risk of stroke increased x 5+ AF responsible for up to 30% of strokes Big variation of stroke risk amongst AF patient ie. 2% to 12% risk pa Antithrombotic treatment of AF based on risk of stroke
8 AF Stroke Risk Assessment CHADS2 Congestive heart failure + 1 Hypertension + 1 Age > 75 + 1 Diabetes + 1 (S2) previous stroke or TIA + 2
9 CHADS2 stroke risk CHADS2 score >1 = high risk of stroke (6% to 12% pa risk) CHADS2 score 1 = medium risk of stroke (3% to 5% pa) CHADS2 score 0 = low risk (1% to 2%) Approx 70% of AF patients at high risk
10 Warfarin vs Aspirin Warfarin (INR 2.5) is significantly more effective than Aspirin 75mg Warfarin strongly indicated if CHADS2 score > 1 point CHADS2 score =1 Risks vs Benefits decision Warfarin is under prescribed, particularly in the elderly
11 Scope for Improvement NICE (CG 36 2006) estimate up to 40% of AF patients whom warfarin indicated not receiving it = 166K patients nationally Possibility of preventing 6,000 strokes and savings 4,000 lives pa
12 Audit Benefits High quality patient care REDUCED STROKES, MORBIDITY & MORTALITY Cost saving Clinical audit QOF points - Med Man Action (plus revised AF3 – 12 pts)
13 Audit Key Objectives All high stroke risk AF patients to be either prescribed warfarin or coded with reason why not. All medium stroke risk AF patients to be considered for warfarin and coded with reason if not Rx.
14 AF Management Issues Increased identification of AF Accurate diagnosis of AF Stroke risk stratification Effective management plan Antithrombotic therapy as appropriate Follow up and review