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Improving detection and management of atrial fibrillation (AF)

What was the challenge?

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a major cause of stroke. People with AF have five times the risk of a stroke compared to those with a normal heart rhythm. AF is responsible for around 20-25% of all strokes in the UK and these strokes tend to be more severe.

What did we do?

The Oxford AHSN developed and implemented a comprehensive collaborative work programme bringing together expertise from the NHS and industry to reduce morbidity and mortality related to stroke caused by atrial fibrillation (AF). We also worked with the other 14 AHSNs in England to deliver a national ‘detect, protect and perfect’ programme to address AF from 2018-2020.

The focus has been on three key areas:

  1. Detecting AF – utilising digital detection devices to support primary care clinicians in detecting AF and evaluating their impact in increasing detection rates
  2. Protecting against stroke – assessing risk and offering oral anticoagulation to those at high risk
  3. Perfecting anticoagulation control – getting medication right, ensuring benefit and avoiding harm

From 2017-20 a range of projects have been run with partners across the Oxford AHSN region. These included:

  • Piloting and evaluating a novel model of anticoagulation initiation within primary care in Berkshire, with pharmacists counselling patients, assessing bleeding and stroke risk and using shared decision-making techniques to decide on appropriate anticoagulation.
  • ‘Excellence in AF in Buckinghamshire’ – this used the skills of specialist pharmacists to identify patients at high stroke risk who were not receiving oral anticoagulation therapy. They were then invited for stroke risk counselling at their GP surgery and offered oral anticoagulation therapy where clinically appropriate. This project was a finalist in the ‘Best Pharmaceutical Partnership with the NHS’ category of the HSJ Partnership Awards 2019. Read more about Excellence in AF.
  • Outreach education and support for GPs and community pharmacists in Oxfordshire led by specialist anticoagulation pharmacists to improve safe and optimal anticoagulation management in the community. The project won an AF Association Healthcare Pioneer Award: ‘Showcasing Best Practice in AF’ and a research paper was published in the British Journal of Haematology in March 2019.

“The Oxford AHSN has been instrumental in delivering a number of key projects in Buckinghamshire and beyond. Innovation, coordination, leadership and support by the AHSN has led to change and significant improvement in patient outcomes.”

Dr Raj Thakkar, GP and Oxford AHSN Cardiac Clinical Lead

What has been achieved?

  • More AF detected
  • Anticoagulation rates improved
  • Stroke rates reduced
  • Risk of future strokes reduced
  • Cost savings by avoiding health and social care relating to long-term care following stroke

What next?

We are continuing to focus on reducing variation across our region and new opportunities for remote monitoring following the Covid-19 pandemic.

Further reading


Hannah Oatley, Clinical Innovation Adoption Manager