Don't Wait to Anticoagulate Project

The Don’t Wait to Anticoagulate project was run in partnership between Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group and the West of England Academic Health Sciences Network. The aim of the project was to reduce the number Atrial Fibrillation related strokes.

The project ran from January 2017 until May 2017 and an evaluation has been undertaken - you can read about the results and conclusion below.

Background

In the next 4 hours:

  • 10 people with Atrial Fibrillation (AF) in the UK will have a stroke:
  • 3 will go home from hospital
  • 5 will need residential care for the rest of their life
  • 2 will die

One way of reducing strokes in people with AF is to prescribe an anticoagulant. For this reason the DWAC project incentivised Bristol’s GP Practices to contact patients with a diagnosis of atrial fibrillation and were either not on an anticoagulant or were not stable on their medication to come in for a review.

Participating Practices invited patients to discuss their risk of stroke and what could be done to reduce that risk. If the patient and their GP agreed that anticoagulation medication was in their best interests, the most appropriate anticoagulant was then prescribed.

The DWAC Project supported primary care providers to improve anticoagulation management for AF patients through a range of supportive measures including Clinical Skills Training, Quality Improvement (Q.I.) Training and Support, Ongoing Clinical and Q.I. Expertise, Prescribing Incentive Scheme Incentivisation and Medicines Optimisation Pharmacist Support.

Results

40 of the 47 practices in Bristol took part on the project, this covered 86% of Bristol’s population.

Patients with AF at risk of stroke, not on anticoagulation

942 patients identified with AF who were at risk, but not anticoagulated (16% AF register).

Patients on warfarin, with a TTR < 65%

TTR (Time Therapeutic Range) less than 65% leads to both increased risk of stroke and increased risk of bleeding and death.

  • 363 patients identified with a TTR < 65%
  • 96 of these patients switched to a NOAC (26%)

Potential number of strokes saved per year in Bristol

  • Total number of patients switched to optimal anticoagulation: 230

Number needed to treat to prevent one stroke = 40

Approximately 6 strokes prevented in one year.

Conclusion

  • A short Quality Improvement (six months) incentivised entirely by an existing prescribing incentive scheme has potentially saved 6 patients in Bristol suffering from a stroke in one year
  • This equates to savings of £144,000 per year (total cost of one stroke to NHS is approximately £24,000 per year)
  • The same strategy on a national level would translate into a total of 636 strokes saved across the population of England and savings of over 15 million pounds in one year
  • Sustainability and outcomes achieved through upskilling practice based nurses and pharmacists in an interprofessional learning environment
  • Optimal anticoagulation expected to continue for new patients being detected through future AF detection screening programmes 

Resources can be found below and on REMEDY. Practices can also find a raft of excellent information and support tools on the WEAHSN’s Don’t Wait to Anticoagulate website.