The National Anticoagulation Initiative aims to decrease strokes in at-risk patients with Atrial Fibrillation (AF), by promoting appropriate, safe and locally available oral anticoagulation. The scalable National AC initiative, which is lead by Professor Sir Muir Gray (of Better Value Healthcare), has been working with influential thought leaders since 2012 to discuss treatment, best practice and benchmarking, with the aim of taking this forward into more populations nationwide.
AF is the most common heart rhythm disorder (arrhythmia) in the world, affecting more than 1.5 million people in the UK; and AF-related strokes are the most debilitating and life-threatening. A quarter of all patients who suffer an AF-related stroke will die within the first month. Only a third of the remaining will return home, with the majority needing full time residential care. Yet AF-related strokes are largely preventable. The National Anticoagulation Initiative aims to do more to protect all AF patients at risk by encouraging clinicians to report on their systems to a publicly available national database to promote shared learning and an understanding of how we, as a healthcare community, can prevent stroke .
A series of workshops have established the initiative and the most recent event brought together representatives from key populations that will be the first to implement the outputs of the whole initiative. The teams have agreed to produce an annual report on a standardised web-based template, which will allow comparisons to be made across the network, so standards of care can be continually improved. The reports will ultimately expand on the objectives and criteria measured by those managing patients with AF, allowing more detailed comparisons between populations. The aim is to draw learnings from those populations where AF is well controlled (and strokes are reduced) and apply those to other populations to assist them in driving up their level of care. The initiative supports recently published NICE guidelines (please see www.nice.org.uk/guidance/cmg4).
Dr Andy Hughes, Consultant Community Haematologist at Brentwood Community Hospital who has been involved in the National AC Initiative comments “The NICE guideline “Support for Commissioners: Anticoagulation Therapy” (of May 2013) stated that there were variations in the quality and safety of anticoagulation; that a large percentage of individuals with AF were not on an oral anticoagulant, and that there was no standard service model. It is these problems that our pilot initiative seeks to address, by having a standard system for delivering care carried out by an integrated network of providers, all using the same standards and measurement criteria.”
Sir Muir Gray explains: “We want the whole population to be covered by a defined number of systems. We are keen that the systems are standardised, but the service may well be different in different areas. For example, the service in some areas may be more pharmacy orientated, while others may be more GP orientated, but both services should deliver the same system. The three key elements of the initiative are: systems, networks and pathways/services. For example, for Systems - What is delivered; for Networks : who delivers and for Pathways/services : How the system is delivered. The networks and pathways/services can be different, and they mostly will be different in different localities, but they should all be delivering against the same system objectives.”
Dr Andy Hughes continues: “Currently services are fragmented, often with little coordination between those who identify patients with AF and those who provide anticoagulation initiation and monitoring. There is also little, if any, contact between services throughout the country. Instead of services working in isolation, an archipelago approach, a coordinated approach is necessary to encourage the identification and proper risk assessment of individuals with AF using the GRASP-AF tool, promote the use of oral anticoagulation in these patients where appropriate, strengthen links with local anticoagulation services and to phase out the inappropriate use of Aspirin”.
INRstar is pleased to support the National AC Initiative. Other key leaders include Dr Andy Hughes and Dr Matt Fay. INRstar is the UK market leader for anticoagulation management software and currently underpins over 2,000 anticoagulation clinics in both primary and secondary care where it assists users in the dosing, monitoring and auditing of anticoagulation patients.
