The Health Innovation Network (HIN) South London and South East London Integrated Care Board (SEL ICB) have partnered to continue work targeting atrial fibrillation by identifying patients who could benefit from life-saving anti-coagulation treatment.

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Atrial fibrillation (AF) is a cardiac condition which causes an irregular heart rate and can decrease the efficiency and effectiveness of the heart. This year the HIN and the South East London Integrated Care Board (SEL ICB) have partnered on targeting AF, to continue the work started with the AF Toolkit Programme, in order to improve the pathway that treatment is being delivered.

Rachel Howatson, Senior Cardiovascular Pharmacist at SEL ICB said ‘the benefits of collaborative working between the HIN and SEL ICB are being experienced by many patients and healthcare professionals across the South East London Integrated Care System and we really are making every contact count.’

Direct oral anti-coagulants (DOACs) reduce the likelihood of patients with AF having a stroke. Following NICE guidance, DOACs are considered both safe and effective for the treatment of  AF and stroke prevention compared with warfarin which was the conventional treatment option. NHS England (NHSE) now recommends that DOACs are first line treatment for anticoagulation of AF. NHSE estimate that 21,700 strokes could be prevented, and 5,400 lives saved over the next three years thanks to these developments. Through new programmes to expand access to DOACs, NHSE have established agreements which have led to a cost saving per patient.

Cardiovascular Disease (CVD) causes a quarter of all deaths in the UK and is the largest contributor to premature mortality in the deprived areas. The NHS Long Term Plan aims to reduce 150,000 cardiovascular events over the next decade of which Atrial Fibrillation is one of the national priorities. The aspiration is to identify 85 per cent of AF cases and improve anticoagulation rates to 90 per cent by the year 2029. People with AF are five times more like to have a stroke, and the British Heart Foundation estimates that 270,000 people aged over 65 are living with undiagnosed AF.

SEL ICS redesigned clinical pathways to ensure more patients have access to the latest treatment according to national and local guidance. The HIN supported the SEL ICS through project management to deliver an AF detection programme. This supports the national aims to increase the detection of AF and we have utilised resources to re-invest in AF detection to identify patients who may benefit from anticoagulation.

Creating clear guidance has been important in terms of the raising awareness of detection of atrial fibrillation as well as its management and ensuring that processes are not prohibitive to the care of patients. This programme is aimed at detecting undiagnosed AF by deploying non-invasive devices that can quickly and accurately detect an irregular heart rate. Patients can then be referred for investigations and treatment. This allows patients to access potentially lifesaving anti-coagulation and reduce their risk of having a stroke.

This work was also supported by the Clinical Effectiveness for South East London (CESEL) programme for AF management and SEL ICB CVD pharmacists working with acute trust specialist pharmacists to upskill and support health care professionals to initiate and manage anticoagulation for patients within primary care.

Working together, the HIN and SEL ICB were able to deliver this project to reduce the risk of heart attacks and strokes. Further work is being started to continue detecting and managing AF across south east London.