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NHS England has developed a new infographic in support of the national initiative to expand the use of direct oral anticoagulants (DOACs), accelerating treatment and improving atrial fibrillation (AF)-related outcomes in England. DOACs are medicines which can prevent strokes by preventing blood clots in patients with AF. Following recent NICE guidance (NG196), which recommends that DOACs are more effective for the prevention of AF-related stroke than other anticoagulants, NHS England has put in place a programme, including a number of agreements, to expand DOAC access.

The new agreements give us the opportunity to prevent thousands of potentially fatal strokes by treating over 600,000 more people with a DOAC, in line with the NHS Long Term Plan commitment to prevent more strokes and improve cardiovascular disease outcomes. With the support of NHS colleagues, this can be delivered through the ‘Detect, Protect, Perfect’ initiative.

Detect: Reduce incidence of stroke by diagnosing more patients with AF.

Protect: Ensure patients diagnosed with AF are offered anticoagulation, where appropriate.

Perfect: Ensure patients with AF are on the correct dose of the best value DOAC (edoxaban), where clinically appropriate. If edoxaban is not clinically appropriate, consider rivaroxaban first, then apixaban or dabigatran.

By doing this, an estimated 21,700 strokes could be prevented and 5,400 lives saved over the next three years.

In 2023/24, NHS England updated the Quality and Outcomes Framework (QOF) AF008 indicator to drive the prescription of DOACs and support best practice.

QOF points are awarded based on the percentage of patients on the atrial fibrillation register being prescribed a DOAC, or where a DOAC was declined or clinically unsuitable, a vitamin K antagonist.

NHS colleagues are urged to capitalise on this chance to improve cardiovascular health outcomes across the country by:

• Taking steps to ensure that each patient in your local area who would benefit from a DOAC is offered treatment.
• Actively raising awareness of the new commissioning recommendations.

This infographic provides a one-page summary of the opportunity to improve patient care and outcomes, the funding in place to support best practice, and the unequivocal support of NHS England, with NHS Medical Director, Professor Sir Steven Powis, stating “by ensuring that all patients who would benefit from a diagnosis of AF and treatment with a DOAC are offered treatment, we have an incredible opportunity to save thousands of lives, and prevent the serious harm caused by having a stroke for thousands more. I would encourage NHS colleagues to take steps to help expand access to DOACs, and to raise awareness of the new recommendations for treatment with a DOAC, to realise the opportunity to improve AF care and reduce preventable stroke events in your area.”