Atrial Fibrillation management and treatment – what can you do?

Written by Kate Mackay on 5th March 2017

Two half-day sessions looking at atrial fibrillation (AF) were held in Newcastle United Football Club’s St James’ Park and, to keep the scores even, Middlesbrough Football Club’s Riverside Stadium. The two sessions mirrored each other giving delegates the option of staying north of the river Tyne or travelling south of The Tees.

Immediately after lunch the chair of the day Professor Oliver James, Medical Director of the AHSN, introduced Ian Dove, Business Development Manager from County Durham and Darlington NHS Foundation Trust and his colleagues to talk about their experiences of patients self-testing INR for their warfarin medication. Despite scepticism from staff the initial project was successful and continues today with 300+ patients currently self-testing. It is important patients are within their therapeutic range 65% or more of the time, and the pilot work demonstrated that this figure increased from 59% to 75% after 6 months of self-testing. Patients were unanimously positive about the change because it allowed many to live their lives more freely. They could now work without being penalised for taking time off to attend hospital clinics and visit and support sick relatives who lived far away. We heard from a patient, Steve Clarke, who spoke about his experience feeling empowered to take charge of his own care.

Joanne Smithson, Digital Health Programme Lead with the AHSN built upon the previous presentation explaining plans for optimising the anticoagulation pathway in Newcastle. This would use genetic testing to discover which patients are sensitive to warfarin, and thus not suitable to receive the treatment. Also, by offering self-testing to patients who prove not to be sensitive to warfarin they receive the same benefits as those in Durham and Darlington. The one-year pilot will test the new pathway and will be funded by a grant from Pfizer.

Shared decision making was a large theme for the day and was delivered by Professor Richard Thomson from Newcastle University and NICE Technical Advisor Andy Hutchinson, the later of whom sat on the panel for a discussion on Warfarin versus DOACs – the real world. He was joined by other panel members who varied between the two locations, but included a consultant cardiologist and a GP. The debate was lively, with panel members being challenged by Professor James who asked a number of contentious questions. This was opened up to the floor and delegates had a chance to ask questions directly to the panel. Treatment options for AF, with DOACs being considerable more expensive than warfarin, provokes strong reaction in some. The Newcastle audience proved to be more voluble and polarisation of views made for robust but respectful debate.

The day finished with myself outlining the AHSN AF projects and the results to date focusing on the AF Card Deck which was circulated to all 2200 GPs across the area, pulse detection work using the NICE approved device AliveCor and the AF Review pilot project examining AF registers in primary care to support staff to ensure patients are being optimally treated. Support was available on the day from the Stroke Association and NICE, both of whom had stands at the events.

Initial evaluations from delegates are extremely positive, and whether they supported Newcastle United or Middlesbrough FC, both events scoring highly at their respective venues.