1. Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013 Coastal West Sussex CCG

2. South East Coast SCN -Atrial Fibrillation Project Earlier detection and anticoagulation optimisation of patients with atrial fibrillation First step will be agreement on recommendation of NICE anticoagulation guidelines as best practice. New NICE Guidance will be published on the 11 th June 2014 Task to Finish Group being established to implement the NICE guidance Will be followed by the development of a best practice model for earlier detection and management SSNAP Data – July to September 2013 most up to date QOF Data from 2012/13 most up to date Uses CHADS2 scoring. This will be replaced by CHADSVASC in NICE Guidance

3. SSNAP Data – July to September 2013 Nationally 19.8% of Stroke patients had previous AF. SEC is 20.5 %.Range in SEC is 12.7 to 35.5% Best practice is anticoagulant prescribing for AF Nationally 24.5% of Stroke patients with AF were not previously prescribed anticoagulants or anti-platelets. SEC is 26.8%. Range is 7.7 % to 40% Nationally 32.5 % of Stroke patients with AF were previously prescribed anticoagulants only. SEC is 31.4%. Range is 0 – 70%

4. SSNAP Data – July to September 2013

7. QOF Atrial Fibrillation Indicators – 2012/13 by CCG Four Indicators – Prevalence (percentage on QOF AF Register/practice population) – AF05 – Percentage on AF register who have had a CHADS2 score in the previous 15 months (except those whose previous score was greater than 1) – AF06 – In those with a CHADS2 score higher than 1 in last 15 months– those who are on anti-coagulants or anti-platelets (minus exceptions) – AF07 – In those with a CHADS2 score higher than 1 in last 15 months – those who are on anti-coagulants (minus exceptions) Any correlation between QOF CCG indicator results and AF stroke admissions and prescribing? E.g. High stroke admissions with AF in local hospitals and low anticoagulant prescribing for those admissions and low prevalence and low anticoagulant prescribing (for the known AF’s) in CCG data

8. AF Prevalence by CCG in Sussex

9. AF05 by CCG in Sussex

10. AF06 by CCG in Sussex

11. AF07 by CCG in Sussex

12. QOF Atrial Fibrillation Indicators – 2012/13 by Practice What to look for – Does the prevalence look low for this practice population and demographics? All other indicators are based on this. Low numbers may mean that some AF patients have not been diagnosed – AF05 – Low rates will indicate that the practice isn’t routinely assessing those on the AF Register for CHADS2 and changes to their risk – AF06 – Best practice is for those with identified AF to be on anticoagulant therapy not anti-platelet therapy. Compare rates with AFO7. High rates on AF06 but lower rates on AF07 indicates a high usage of anti-platelet therapy. – AF07 - Best practice is for those with identified AF to be on anticoagulant therapy. Compare with prevalence and AF05 - high rates but low prevalence and low routine assessment may indicate that only small numbers are being managed well

13. GP Practice Codes in Coastal West Sussex CCG H820861 HIGHDOWN AVENUE H82023ADUR MEDICAL GROUP H82069ARUN MEDICAL CENTRE H82021ARUNDEL SURGERY H82048AVISFORD MEDICAL GROUP H82065BALL TREE SURGERY H82016BERSTED GREEN SURGERY H82055BILLINGSHURST SURGERY H82020BOGNOR HEALTH CENTRE H82046BROADWATER MEDICAL CENTRE H82042CATHEDRAL MEDICAL GROUP H82076CORNERWAYS PRACTICE H82077CROFT SURGERY H82038FELPHAM & MIDDLETON HEALTH CENTRE H82066FITZALAN MEDICAL GROUP H82043GROVE HOUSE SURGERY H82101HEENE ROAD PRACTICE H82060HENFIELD MEDICAL CENTRE H82094KINGFISHER FAMILY PRACTICE H82013LANGLEY HOUSE SURGERY H82051LAVANT ROAD SURGERY H82034LIME TREE SURGERY H82031LOXWOOD SURGERY H82058MAYWOOD HEALTHCARE CENTRE H82068MILL STREAM MEDICAL CENTRE H82091NEW POND ROW PRACTICE H82083NORTHBOURNE MEDICAL CENTRE H82625OLD SHOREHAM ROAD PRACTICE H82049PARKLANDS SURGERY H82006PETWORTH SURGERY H82030PULBOROUGH MEDICAL GROUP H82032RIVERBANK MEDICAL CENTRE H82024SEAL MEDICAL GROUP H82061SELDEN MEDICAL CENTRE H82037SELSEY MEDICAL CENTRE H82078SOUTHBOURNE SURGERY H82009ST LAWRENCE SURGERY H82022STEYNING HEALTH CENTRE H82011STRAND MEDICAL GROUP H82067TANGMERE MEDICAL CENTRE H82087THE BARN SURGERY H82014THE COPPICE PRACTICE H82070THE GLEBE SURGERY H82641THE LAWNS SURGERY H82002THE LYONS PRACTICE H82029THE MANOR PRACTICE H82643THE MAYFLOWER SURGERY H82096THE ORCHARD SURGERY H82039THE PARK SURGERY H82015THE PHOENIX SURGERY H82041VICTORIA ROAD PRACTICE H82099WEST MEADS SURGERY H82007WESTCOURT SURGERY H82059WILLOW GREEN SURGERY H82095WITTERINGS HEALTH CENTRE H82045WORTHING MEDICAL GROUP

14. Prevalence by Practice compared to KSS (Red line) and England (Green Line)

15. AFO5 by Practice compared to KSS (Red line) and England (Green Line)

16. AFO6 by Practice compared to KSS (Red line) and England (Green Line)

17. AFO7 by Practice compared to KSS (Red line) and England (Green Line)