Atrial Fibrillation

(asked on 7th November 2016) - View Source

Question to the Department of Health and Social Care:

To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 1 November (HL2501), whether they intend to publish the key findings from the data collected through the GRASP-AF tool, saved on CHART online, to allow variations in services, diagnosis and care for patients with atrial fibrillation to be identified and addressed.


This question was answered on 21st November 2016

CHART Online allows NHS England’s Sustainable Improvement Team to easily track the use of the Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation (GRASP-AF) amongst general practitioner (GP) practices. However, there are a number of other tools in addition to GRASP-AF that are available to GPs to help audit management of atrial fibrillation (AF) patients. The Sustainable Improvement Team cannot easily track the use of these alternative tools, and many of the 58 clinical commissioning groups (CCGs) not using GRASP-AF, may be using one of these alternative tools. However, the Sustainable Improvement Team’s partnership with NHS RightCare will enable it to revisit practices in these CCGs to confirm the use of an alternative tool and to encourage the use of GRASP-AF in those practices that are not using, currently using it or an alternative.

The Sustainable Improvement Team uses aggregate data at CCG level or higher to help raise awareness of its work and to promote local improvement in the management of AF and has published a paper on the use of GRASP-AF and what it shows about the management of AF. A copy of the paper The use of anticoagulants in the management of atrial fibrillation among general practices in England is attached. The team also shares high level CHART Online data with organisations such as the Atrial Fibrillation Association and Public Health England.

The following table sets out information on variation in the prevalence and management of patients with AF.1

CCG level variation in the recorded prevalence and management of patients with AF

Mean

Range

AF Prevalence

1.88%

0.75-2.91%

% of AF patients at high risk of stroke (CHADSVASc of 2 or more2 ):

58.6%

51.8-65.9%

% of AF patients at high risk and on oral anticoagulant (as recommended by the National Institute for Health and Care Excellence [NICE]):

63.5%

48.3-80.8%

% of AF patients at high risk and on aspirin alone (not recommended by NICE)3:

27.9%

11.3-42.5%

Source: NHS England

1. These figures include only those CCGs which have at least 50% of their practices uploading to CHART Online, to avoid the data being skewed by individual practices.

2. CHADSVASc calculates stroke risk for patients with atrial fibrillation.

3. The removal of aspirin from the Quality Outcomes Framework some time ago may filter into the system as will continued adoption of the NICE guidance from 2015.

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