Atrial Fibrillation

The Atrial Fibrillation (AF) programme, which ran as a national programme from 2018-2020, led to the development of several valuable resources. In addition, one key project from this work continues to operate as a legacy project.

Legacy project

HI NENC worked collaboratively with Bristol-Myers Squibb (BMS) on behalf of BMS-Pfizer Alliance, to reduce AF related strokes through the optimisation of anticoagulation medicine. As a result of this work, service improvements have been made to the AF care pathway to reduce unwarranted variation to patient care across GP practices across the Southern Collaborative.

Patient impact: 6,350 patients were reviewed across County Durham during the project and 622 additional patients were anticoagulated

Read more about the project in this poster, which was presented at a conference in July 2023.

Further information about the project can be found in this executive summary.

Although the partnership working has ceased, this work is continuing in Tees Valley until March 2025, as agreed in this termination statement from BMS.

The National AF Programme prevented 57 strokes and potentially avoided costs of £2.1M (health and social care over 5 years), (Xiang, M.X. et al, European Stroke Journal, 2018; 3(1):82-91)

AF resources

1. AF Card Deck: a resource aimed at primary care staff, providing a step by step guide for anticoagulation treatment in AF for the prevention of stoke and systemic embolism. Every GP in the NENC area received a hard copy.
   – A4 black and white guide or full colour guide are available for you to download and print to be incorporated into any training manuals in your practice.
   – A digital version to view online – with working bookmarks and hyperlinks.
   – A web app (an app that runs on a website browser), which can accessed and downloaded to your PC or smart device home screen. The app is new for this edition and provides instant access to the resource and minimises the risk of infection control by reducing paper use. View or install the web app here.
2. Detection of irregular pulses during a diabetes foot check. Diabetes is a common condition affecting 3.4M people across England. Patients with diabetes have their pulse checked as part of their annual foot check review. All patients aged 12 and over should be offered a foot check. It is important to detect the presence or absence of a foot pulse to prevent diabetes complications. The pilot work examining pulses in patients’ feet started in County Durham and Darlington NHS Foundation and is now being spread across the NENC area as well as more widely across England. For information about the pilot, download the ‘Stop a Stroke, Save a Life’ flyer. The aim is that this will become standard practice across the country, and we are contributing to work to make this happen.
3. Opportunistic pulse checks using AliveCor: supporting local clinicians using the mobile ECG device, AliveCor, to detect patients with possible AF. The AliveCor project results for NENC and the results for the national AF Detection project can be found in the project report Download AliveCor Project Report NENC. See the resources section below for information about using Alivecor in your practice.
4. Shared decision-making (SDM) videos and resources to support HCPs discussing AF treatment options with patients: a series of films were produced to assist with SDM. These included an introduction to SDM as well as demonstration of the skills needed by a pharmacist, GP, a specialist nurse and consultant cardiologist. Each one lasts 10 – 13 minutes. There is also a SDM Top Tips Guide available. Further information can be found here.
5. Anticoagulation with Jack: an animated video produced by Health Innovation Wessex is a five minute film aimed at patients to support the use of anticoagulants.
6. NOAC (DOAC) Alert Card: this was developed by Northern England Clinical Network for patients treated with a DOAC rather than warfarin. Further information, including order of additional supplies, can be found here.
7. Many resources in relation to AF can be found in the National AF Toolkit, which has been produced by AHSN Network (now Health Innovation Network).