Where are we with AF in the West Midlands? Dr Indira Natarajan Clinical Director Cardiovascular Diseases West Midlands SCN

Atrial Fibrillation & Stroke The UK Spends £8.9 billion on stroke each year, 27% of this relates to direct care costs[13] Stroke is a leading cause of adult disability [14] with an estimated 31.2% of AF stroke patients are admitted into care homes[6 In 2006 NICE used the 2004 Sentinel Audit estimated that 12,500 strokes (14%) were caused by AF. In 2010 the National Sentinel Audit found that 21% of all strokes occurred in patients with Atrial Fibrillation[10]

Atrial Fibrillation and Stroke It is estimated that 4,500 strokes per annum and 3000 deaths may be preventable with simple highly effective anticoagulation treatment. The financial cost of this condition is estimated to be almost 1% of the entire NHS budget. 64% of AF Stroke Patients are NOT Anticoagulated, 38% of these Patients are on Aspirin [10] (SSNAP, 2012) The estimated cost of each Stroke £23,315 [15] Cost ranges from £ 11,900 per year - £40,000 per year Evidence tells us that for every 37 high risk patients treated with anticoagulants we can expect prevent 1 stroke.

In the West Midlands… In the West Midlands there are an estimated 1,250 strokes directly attributable to AF.  Up to 450 strokes and 300 deaths per annum may be preventable.  If those 450 stokes per annum can be prevented then a £19.8m cost saving could be made across the health economy, along with 300 deaths and gains in quality of life.  

Current AF Prevalence in the West Midlands by CCG (QOF)

Predicted AF Prevalence in the West Midlands by CCG (NCVIN)

Some assumptions NICE guidance suggests 84% of those on the AF register will now be considered ‘high risk’ and should be considered for anticoagulation NHS IQ suggests that on average 85% of those high risk AF patients will be eligible for anticoagulation, 15% will be exception reported

The calculations West Midlands Current practice Current potential Predicted AF Register 95,009 147,097 High Risk 20,953 79,808 123,561 Treated with OAC 19,551 67,836 105,027 Strokes prevented 528 1,833 2,839

What does that look like?

Potential strokes prevented 2,839 1,833 Currently 528 strokes prevented each year under current management Just changing the risk stratification and management of those on the AF registers right now could result in 1,833 strokes being prevented – that’s 1,300 more strokes being prevented across the region every year by falling in line with the NICE guidelines. If AF prevalence was as predicted by the NCVIN, 2,839 strokes could be prevented each year – another 2,300 strokes on top of what is already being done; approximately 1/3 of stroke admissions in the region. 528

Significant savings across the region £34.7m £22.4m £6.5m

What next? The prevalence data will be available on the NCVIN shortly and is available via the SCN An updated dashboard is in production and will be available on the SCN website in the near future

Thank You