Atrial Fibrillation (AF) Card Deck

Overview

A card deck to support Atrial Fibrillation (AF) diagnosis and management in primary care has been created by the AHSN North East and North Cumbria.  Endorsed by the Atrial Fibrillation Association and the Stroke Association, as part of joint work with Northern England Clinical Networks, the cards act as a resource designed to help GPs manage their patients with AF more effectively. The cards contain top tips, self-assessment checklists, anticoagulant information and references to patient and professional material.

The cards were developed by GP Dr Nigel Rowell with input from a range of prominent healthcare professionals and have been distributed to almost 2,200 GPs across the North East and North Cumbria area.  The aim of the cards is to increase awareness of AF and in turn reduce the number of strokes that occur as a result of undiagnosed and poorly treated AF.

Challenge/Problem Identified

AF is the most common heart rhythm disturbance, it affects around one million people in the UK 1 in 10 of which are aged over 65 (CG 180, NICE); it commonly displays no symptoms in those affected.

While around 2.4% of the population are estimated to be living with AF, the current diagnosed prevalence rate is only 1.6%, suggesting that approximately 474,000 people are living with undiagnosed AF across England; (National Cardiovascular Intelligence Network, PHE).  One in 20 patients with untreated AF will have a stroke. (Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke: a systematic review.)

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A stroke costs £24,217 (Sentinel Stroke National Audit Programme, 2014/15). This includes inpatient, post discharge, rehabilitation and care costs.  AF-related strokes are more serious with 2 out of 5 dying, 2 going into an institution and only 1 going home.

There are an estimated 22,933 patients with undiagnosed AF in the North East & North Cumbria area (National Cardiovascular Intelligence Network, PHE).  If everyone in the North East and North Cumbria area with AF was detected the health economy could save £27.5M.

AF is an area which has burgeoned recently with new anticoagulants available and clear guidance on assessing risk. Most GPs will come across new patients often as a surprise and it was the aim of the AHSN & North of England Cardiovascular Network to produce a desktop aid that a GP could reach for in these consultations.

GP, Dr Nigel Rowell, CVD Lead from South Tees Clinical Commissioning Group (CCG)

Actions Taken

To help detect AF in Primary Care a set of colourful, hand held cards have been produced.  They are held together with a key ring fastening and offer advice and protocol for GPs to assist in detecting AF.

The cards were created, designed and distributed by the AHSN. Instrumental in the AF cards’ production was GP, Dr Nigel Rowell, CVD Lead from South Tees Clinical Commissioning Group (CCG) in conjunction with the Academic Health Science Network (AHSN) and Northern Clinical Networks and Senate.

Effects of AF-related stroke are much more serious with two out of every five ending in death, another two going into an institution and only one in five making a recovery. We hope that by distributing the card decks to GPs practices we can provide a simple but effective tool to manage this heart condition.  Working alongside the AHSN we’ve been able to make the cards commercially viable, suitable for the mass market within the NHS.

GP, Dr Nigel Rowell, CVD Lead from South Tees Clinical Commissioning Group (CCG)

Impacts / Outcomes

The key impact for a patient will be the awareness of having AF; they can then access the correct support and medication to manage the condition therefore avoiding a stroke. In turn, the associated costs for treating and caring for stroke victims could decrease.

The key outcomes are –

  • A practical, hand held step by step 12 page guide has been distributed to 2,200 GP’s across the region
  • Of those who had seen the card 42% used it and 16% of these had changed practice as a result
  • Two other AHSNs have each ordered 500 copies of the cards

Further expected impacts are –

  • Increased awareness of AF to assist with diagnosis in those who were previously unaware of the condition
  • Subsequent management and medication of AF in those who were previously unaware
  • A reduced number of hospital stays through early diagnosis which will result in cost savings

“The AF card deck has been a really useful resource. It has been distributed to all GPs in our CCG. It has answers to the commonly asked questions on anti-coagulation in AF and data showing the importance of anti-coagulating high risk AF patients. The card deck supports Clinicians in conveying complex information to help their patients make a decision on what will be the right treatment for them.”

Steve Kirk  Clinical Director for Delivery, Newcastle Gateshead Clinical Commissioning Group (CCG)

Plans for the Future

Immediate plans include:

  • A revision to be undertaken as a result of an evaluation to include a specific card on warfarin.
  • An electronic version of the card deck, available to download.
  • 500 sets of cards have been ordered by both North West Coast AHSN and Yorkshire & Humber AHSN.

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