AF prevalence increases sharply with age, with 80% of cases occurring in people over 65, with prevalence likely to double over the next few decades with an ageing population living longer with heart disease. In stroke registers, at least a third of patients with ischaemic stroke have either previously known or newly detected AF at the time of stroke. Stroke was the first manifestation of AF in less more than 25 % of AF-related strokes. We have very effective anticoagulants reducing the risk of ischaemic stroke by up to 70% with a NNT (Number Needed to Treat) of 37 patients on anticoagulation treatment to prevent 1 stroke per year.Public Health England estimates there over 27,500 undiagnosed AF patients within East Midlands (23.1% undiagnosed). The AF prevalence as at March 2017 is 1.94% compared to an estimated prevalence of 2.54%.

Who are the partners

• clinical commissioning groups
• acute trusts
• local authorities
• East Midlands Academic Health Science Network
• Public Health England East Midlands
• Third sector organisations – Atrial Fibrillation Association and British Heart Foundation

How are we making a difference

East Midlands Clinical Network are working jointly with East Midlands Academic Health Science Network, Public Health England, Health Education East Midlands, Heart Rhythm Alliance, AF Association & British Heart Foundation to further support CCGs in 2017-18 in stroke prevention in atrial fibrillation:

• Providing tailored support to the 6 CCGs in East Midlands with the lowest anticoagulation treatment rates to help them achieve anticoagulation uptake of 89% by March 2019.
• Increase AF diagnosis by 10% by March 2019 in 16 CCGs through the effective deployment of AliveCor Kardia mobile ECG devices to support the diagnosis of AF.

What’s next

• Update atrial fibrillation slide set (reduced version) and infographics to show improvement in atrial fibrillation diagnosis and anticoagulation and make case for continued improvement focus by clinical commissioning groups
• Support adoption of atrial fibrillation clinical template and GraspAF to support improved diagnosis and management of atrial fibrillation
• Hold community practice atrial fibrillation workshop in January 2016 to support clinical commissioning groups to develop robust plans to improve diagnosis and anticoagulation management
• Provide funding to clinical commissioning groups to support delivery of upskilling training for primary care staff in atrial fibrillation and heart failure management
• Complete academic review of atrial fibrillation improvement programme

Who to contact for further information

Martin Cassidy, Head of Network – Diabetes with Vascular Diseases