Preventing strokes in people with atrial fibrillation by improving ABC

[摘要] Nationally, anticoagulation for atrial fibrillation (AF) isimproving but remains characterised by marked providervariation. Uncontrolled blood pressure and coronaryartery disease further increase cardiovascular risk.Redbridge Clinical Commissioning Group (CCG) and localNational Health Service (NHS) hospital trusts supporteda programme to improve anticoagulation, blood pressureand cholesterol management; the ABC of AF improvement.The programme was delivered by a clinical pharmacistin 43 general practices, who used Active Patient Link(APL-AF) software to identify and electronically reviewthe records of AF patients potentially suitable foranticoagulation. These patients were invited for a generalpractitioner (GP)-pharmacist consultation with initiationof anticoagulation where appropriate. Blood pressure andlipid treatment were also optimised.The university-based Clinical Effectiveness Group(CEG) provided software support using standard dataentry templates from which the APL-AF softwarewas enabled. This identified suitable patients (eg, onaspirin monotherapy, no treatment or inappropriatedual treatments) for clinical and treatment review. Italso reported real-time overall practice performance.Additionally, GP education on direct oral anticoagulantinitiation in general practices, use of software andperformance reviews, took place for all practices inRedbridge.A weekly multidisciplinary team (MDT) video conferencediscussed complex patients with a cardiologist,haematologist, GP with specialist interest in cardiology, GPcoordinator and clinical pharmacist. This enabled sharingof patient records between GPs and hospital specialistswith improved communication and learning.Over 1 year 2016–2017, anticoagulation in eligible AFpatients (CHA2DS2-VASc≥2) increased significantly by 6.3%from 77.0% to 83.3% (p<0.0001), in comparison to 2.8%average improvement in England. Exception reporting wasalso significantly reduced from 10.0% to 5.8%; a reductionof 4.2% in comparison to a reduction in England of 1.5%.Use of antiplatelet monotherapy was approximately halved,from 12.3% to 6.4%.These methods are being scaled locally in other LondonCCGs and are potentially scalable nationally, specificallytargeting the poorer performing CCGs.

[学科分类] 药学