Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013

1. Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013 North West Surrey CCG

2. 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

3. 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%

4. SSNAP Data – July to September 2013

7. 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

8. AF Prevalence by CCG in Surrey

9. AF05 by CCG in Surrey

10. AF06 by CCG in Surrey

11. AF07 by CCG in Surrey

12. 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

13. GP Practice Codes in North West Surrey CCG

14. Prevalence by Practice compared to KSS (Red line) and England (Green Line)

15. AFO5 by Practice compared to KSS (Red line) and England (Green Line)

16. AFO6 by Practice compared to KSS (Red line) and England (Green Line)

17. AFO7 by Practice compared to KSS (Red line) and England (Green Line)