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Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013 Canterbury and Coastal CCG South East Coast SCN -Atrial Fibrillation Project • Earlier detection and anticoagulation optimisation of patients with atrial fibrillation • First step will be agreement on recommendation of NICE anticoagulation guidelines as best practice. New NICE Guidance will be published on the 11th June 2014 • Task to Finish Group being established to implement the NICE guidance • Will be followed by the development of a best practice model for earlier detection and management • SSNAP Data – July to September 2013 most up to date • QOF Data from 2012/13 most up to date • Uses CHADS2 scoring. This will be replaced by CHADSVASC in NICE Guidance SSNAP Data – July to September 2013 • Nationally 19.8% of Stroke patients had previous AF. SEC is 20.5 %.Range in SEC is 12.7 to 35.5% • Best practice is anticoagulant prescribing for AF • Nationally 24.5% of Stroke patients with AF were not previously prescribed anticoagulants or anti-platelets. SEC is 26.8%. Range is 7.7 % to 40% • Nationally 32.5 % of Stroke patients with AF were previously prescribed anticoagulants only. SEC is 31.4%. Range is 0 – 70% SSNAP Data – July to September 2013 Admitted Stroke Patients with Previous AF SSNAP - July to September 2013 AF Strokes = 306 40 35 30 % 25 20 15 10 5 0 Stroke Patients with Previous AF on no anticoagulant or anti-platelet medication SSNAP - July - September 2013 AF Strokes = 306 45 40 35 30 % 25 20 15 10 5 0 Stroke Patients with Previous AF- Prescribing prior to admission SSNAP July to September 2013 AF Strokes = 306 Worthing Hospital St Richards Hospital East Surrey Hospital Royal Surrey County Hospital Medway Maritime Hospital Tunbridge Wells Hospital Maidstone District General Hospital Frimley Park Hospital % Epsom Hospital Anti-platelet only Eastbourne District General Hospital Anticoagulant Only Conquest Hospital Both William Harvey Hospital Queen Elizabeth the Queen Mother Hospital Kent and Canterbury Hospital Darent Valley Hospital Royal Sussex County Hospital Princess Royal Hospital Haywards Heath St Peter's Hospital National 0 10 20 30 40 50 60 70 80 QOF Atrial Fibrillation Indicators – 2012/13 by CCG • Four Indicators – Prevalence (percentage on QOF AF Register/practice population) – AF05 – Percentage on AF register who have had a CHADS2 score in the previous 15 months (except those whose previous score was greater than 1) – AF06 – In those with a CHADS2 score higher than 1 in last 15 months– those who are on anti-coagulants or anti-platelets (minus exceptions) – AF07 – In those with a CHADS2 score higher than 1 in last 15 months – those who are on anti-coagulants (minus exceptions) • Any correlation between QOF CCG indicator results and AF stroke admissions and prescribing? E.g. High stroke admissions with AF in local hospitals and low anticoagulant prescribing for those admissions and low prevalence and low anticoagulant prescribing (for the known AF’s) in CCG data AF Prevalence by CCG in Kent KENT Percentage of people on practice list on atrial fibrillation register 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Ashford Source: QOF 2012/13 Canterbury & Coastal Dartford, Gravesham & Swanley Medway Practice South Kent Coast KSS KENT England Swale Thanet West Kent AF05 by CCG in Kent KENT AF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1) 100.0% 99.0% 98.0% 97.0% 96.0% 95.0% 94.0% 93.0% Ashford Source: QOF 2012/13 Canterbury & Coastal Dartford, Gravesham & Swanley Medway Practice South Kent Coast KSS KENT England Swale Thanet West Kent AF06 by CCG in Kent KENT AF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15 months), the percentage of patients who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy. 98.0% 97.0% 96.0% 95.0% 94.0% 93.0% 92.0% 91.0% 90.0% Ashford Source: QOF 2012/13 Canterbury & Coastal Dartford, Gravesham & Swanley Medway Practice South Kent Coast KSS KENT England Swale Thanet West Kent AF07 by CCG in Kent KENT AF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation drug therapy 86.0% 84.0% 82.0% 80.0% 78.0% 76.0% 74.0% 72.0% 70.0% Ashford Source: QOF 2012/13 Canterbury & Coastal Dartford, Gravesham & Swanley Medway Practice South Kent Coast KSS KENT England Swale Thanet West Kent QOF Atrial Fibrillation Indicators – 2012/13 by Practice • What to look for – Does the prevalence look low for this practice population and demographics? All other indicators are based on this. Low numbers may mean that some AF patients have not been diagnosed – AF05 – Low rates will indicate that the practice isn’t routinely assessing those on the AF Register for CHADS2 and changes to their risk – AF06 – Best practice is for those with identified AF to be on anticoagulant therapy not anti-platelet therapy. Compare rates with AFO7. High rates on AF06 but lower rates on AF07 indicates a high usage of anti-platelet therapy . – AF07 - Best practice is for those with identified AF to be on anticoagulant therapy . Compare with prevalence and AF05 - high rates but low prevalence and low routine assessment may indicate that only small numbers are being managed well GP Practice Codes in Canterbury and Coastal CCG G82179 BOUGHTON MEDICAL CENTRE G82228 CANTERBURY MEDICAL PRACTICE G82012 COSSINGTON HOUSE SURGERY G82029 DR GARROD P J & PARTNERS G82060 DR GRICE D J P & PARTNERS G82061 DR JOHNSON L F & PARTNER G82115 DR JONES G L & PARTNERS G82790 DR KINNERSLEY D S & PARTNER G82027 DR LOGAN L C & PARTNERS G82082 DR MOLONY J P & PARTNERS G82204 DR Q M MANGI & PARTNER G82071 DR RIBCHESTER J M & PARTNERS G82726 DR SHAR M B & PARTNER G82119 DR SIGURDSSON R G & PARTNERS G82802 DR SIMMONDS R & PARTNER G82138 DR SMITH A & PARTNERS G82040 LONDON ROAD SURGERY G82063 MARKET PLACE SURGERY G82039 NEWTON PLACE SURGERY G82090 ST ANNES GROUP PRACTICE G82148 THE BUTCHERY SURGERY G82004 THE FAVERSHAM HEALTH CENTRE G82140 UNIVERSITY MEDICAL CENTRE Prevalence by Practice compared to KSS (Red line) and England (Green Line) NHS CANTERBURY AND COASTAL CCG Percentage of people on practice list on atrial fibrillation register 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Source: QOF 2012/13 Practice KSS AFO5 by Practice compared to KSS (Red line) and England (Green Line) NHS CANTERBURY AND COASTAL CCG AF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1) 120% 100% 80% 60% 40% 20% 0% Source: QOF 2012/13 Practice KSS AFO6 by Practice compared to KSS (Red line) and England (Green Line) NHS CANTERBURY AND COASTAL CCG AF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15 months), the percentage of patients who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy. 120% 100% 80% 60% 40% 20% 0% Source: QOF 2012/13 Practice KSS AFO7 by Practice compared to KSS (Red line) and England (Green Line) NHS CANTERBURY AND COASTAL CCG AF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation drug therapy 120% 100% 80% 60% 40% 20% 0% Source: QOF 2012/13 Practice KSS