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

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

AF05 by CCG in Kent

AF06 by CCG in Kent

AF07 by CCG in 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 South Kent Coast CCG AYLESHAM PRACTICE G82111 CEDARS SURGERY-DEAL G82007 CHURCH LANE SURGERY G82818 DOVER MEDICAL PRACTICE G82217 DR AMIN Y Y G82700 DR BAHADUR T G82760 DR BANIK A N & PARTNER G82665 DR CAWDRON B A G82072 DR DOWNIE P L G82232 DR FERNANDES M A A G82696 DR FORD M R G82091 DR HOSSAIN M A & PARTNERS G82069 DR JEDRZEJEWSKI J A & PARTNERS G82015 DR MOTTERSHEAD A C & PARTNERS G82036 DR SHARVILL N J & PARTNERS G82227 DR WRIGHT L M & PARTNER G82187 FOLKESTONE EAST FAMILY PRACTICE G82165 HAWKINGE AND ELHAM G82684 NEW LYMINGE SURGERY G82147 OAK HALL SURGERY G82160 OAKLANDS HEALTH CENTRE G82662 PENCESTER HEALTH G82128 PETER STREET SURGERY G82121 SANDGATE SURGERY G82002 ST JAMES SURGERY G82038 ST RICHARDS ROAD SURGERY G82018 SUN LANE SURGERY G82117 THE HIGH STREET SURGERY G82086 THE NEW SURGERY G82652 THE SURGERY G82729 WHITE CLIFFS MEDICAL CENTRE

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

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

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

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