A poster presentation at the Royal College of GPs Annual Conference in Harrogate showed that a review of 135,000 patients with atrial fibrillation led to over 25,000 medical interventions, prevented hundreds of strokes and saved the NHS millions of pounds. The review was carried out by clinical pharmacists from Interface Clinical Services in conjunction with the GPs from over 1,000 GP practices across the UK.
The RCGP annual conference is being held in Harrogate from 6th to 8th October, with more than 1,600 GPs and healthcare professionals attending.
AF is one of the most common forms of abnormal heart rhythm and a major cause of stroke. The abnormal rhythm prevents the heart from pumping effectively allowing blood to pool in the upper chambers called the atria. This pooling can result in the formation of a clot which can break loose and cause a stroke.
Professor Mark Baker, NICE’s Director of Clinical Practice, commenting on the AF NICE guidance, said: “We know that AF increases the risk of strokes by up to five times. It’s estimated that the condition causes around 12,500 strokes each year. We also know that around 7,000 strokes and 2,000 premature deaths could be avoided every year through effective detection and protection with anticoagulant drugs that prevent blood clots forming.”*
Dr John Wearne, a GP from Cheshire who took part in the review commented “This exercise has been hugely beneficial to patients at our practice. The Interface pharmacist analysed the data and identified the patients that we should review together. I found their input invaluable as we would never have had the time or resources to undertake a review of such complexity which ultimately has such a significant effect for our patients. The industry support which made this possible is the type of industry partnership which really is beneficial in delivering high class, patient centric care.”
Mike Drakard CEO of Interface Clinical Services, whose organisation worked in partnership with GPs on this review, said: “This was one of the largest projects we have undertaken and based on NICE’s figures we believe that this review has prevented more than 800 strokes and over 200 deaths. The average cost of treating a stroke, rehabilitation and community support is at least £24,855#, therefore, conservatively we estimate a saving of over £20 million for the NHS as a whole.”
Key results of the service were:
• Of the 36,327 patients who were not taking any type of oral anticoagulants – 12,516 were prescribed VKA – vitamin K antagonist – therapy and 4,189 were prescribed the new non-VKA anticoagulant drugs.
• Of the 89,455 patients already on oral anticoagulant medication – 8,774 moved from VKA to the new anticoagulant drugs – NOACs – and 2,743 on the new anticoagulant drugs had their dose adjusted or were taken off the drug due to clinical issues.
• Those patients who were not taking their drugs regularly were sent letters to encourage adherence.
• The review also highlighted patients who needed secondary care referrals to a haematologist.
• The GP in consultation with the patient then made the decision on the best treatment for that patient going forward.
Mike Farrar who was CEO of the NHS Confed and worked in the NHS as a senior manager for more than 20 years commented, “This type of exercise is great for patients and the NHS in terms of outcomes and savings. As long as the data and prescribing decision is always under the control of the GP, these types of partnerships should be encouraged.”
Research in this area indicates that if the NHS can target their resource to ensure patients with the greatest need get the best care and medication early in their disease it will have the best effect in achieving improved outcomes.
About Interface Clinical Services
Interface Clinical Services is an independent supplier of clinical support services. They have over 70 pharmacists helping GPs, practice managers, administrators, and commissioners to manage long term conditions, improve patient care and maximise QOF outcomes. To date, Interface has worked in 3,470 primary care practices throughout the UK, helping to improve the quality of prescribing for millions of people. Interface also work with the healthcare industry providing solutions on clinical research, market access, business intelligence, and new product indications.
# National Audit Office. “Progress in improving stroke care, Report on the findings from our modelling of stroke care provision” (February 2010). NAO Report (HC 291 2009-2010). Retrieved from https://www.nao.org.uk/wp-content/uploads/2010/02/0910291_modelling.pdf