The Atrial Fibrillation (AF) programme was active in the East Midlands from 2016 and focused on improving the detection and treatment of AF in primary care.

This was achieved through sharing learning and best practice in embedding detection approaches in to existing pathways and providing skills support to improve treatment.

The programme also supported increased collaboration between GPs and other clinical support groups, such as pharmacists, to deliver more timely treatment and evaluation of these approaches.

Solutions / action taken

The AF programme was selected as a national priority programme from 2018-20, and aimed to:

• Detect– Improve diagnosis of those with high risk of AF
• Protect– Improve management through anticoagulation treatment
• Perfect– Optimise anticoagulation therapy

A number of methods have been adopted as part of this work including:

• Building awareness and relationships with primary care and GPs
• The use of AF ambassadors across CCGs and GP practices to drive improvement measures
• Upskilling regional workforce activities related to detection of AF and optimisation of therapy
• Deployment of 925 ECG devices to GP practices and support services to aid detection
• Supporting system use of audit tools to inform action planning and re-audit of improvement
• Evaluating collaborative approaches between GPs and other clinical support groups

The impacts we have achieved are underpinned by system-wide collaboration across the East Midlands including; East Midlands Clinical Network, Public Health England, Health Education England, NHS RightCare, British Heart Foundation, the Stroke Association and the Arrhythmia Alliance.

Recent work has concentrated on commissioning extra support to health and care colleagues in the areas that have the lowest levels of detection and anticoagulation therapy. This includes a pilot virtual AF clinic led by pharmacists and a focused workforce training package and patient videos – aiming to reach those who are detected as having AF but not being managed through anticoagulation.

Impact and outcomes from the project

Between April 2016 and March 2020, the programme achieved the following in the East Midlands:

• Deployed 925 devices to the participating GP practices and support services in the East Midlands to increase detection and protection rates.
• Supported the treatment of an additional 25,127 people diagnosed with AFSupported our East Midlands health system to achieve a 90% anticoagulated rate of people diagnosed with AF by March 2020 (against a national target of 90% by 2029)
• Contributed to the avoidance of 1,005 AF-related strokes*Contributed to the avoidance of 251 AF-related deaths**Saved the East Midlands health system £13.5m***
• Saved the East Midlands social care system £9m***

*Stroke calculation is based on 1 avoided stroke for every 25 patients anticoagulated

**Calculation of deaths avoided is based on a stroke fatality rate of 1 in 4

***Costs avoided/saved are based on average costs in the first year following a stroke of £13,452 for the NHS and £8,977 for social care.

Key lessons learned

Several key lessons have been learned throughout the delivery of the AF programme, which will inform continuous improvement and shared best practice across the EMAHSN and the wider AHSN network. These include the importance of:

• Taking a patient-centred approach– Patient involvement and engagement activities must be a priority during all stages of national and local adoption and spread programmes.
• Early engagement with commissioners and clinical leads– Having early engagement and planning discussions with relevant regional commissioners and clinical leads is imperative. Understanding what the current regional system delivers and how and what needs to be adopted and tailored ensures the best regional fit and outcomes. For example, understanding local IT/technology systems, current pathways/approaches and local budget planning to support and evidence in-year savings.
• Aligning the national to fit local delivery– Delivery of a national programme must build on and enhance the great work that is already underway in the local system.
• Collaborating with partners– Ambitious programmes of this nature require a collaborative approach, drawing on the work and expertise of partners working across the local system.