Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013 West Kent 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 11 th 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 West Kent CCG G82013AMHERST MEDICAL PRACTICE G82058AYLESFORD MEDICAL CENTRE G82074BEARSTED MEDICAL PRACTICE G82098BLACKTHORN MEDICAL CENTRE G82120BOROUGH GREEN MEDICAL PRACTICE G82025CLANRICARDE MEDICAL CENTRE G82777COBTREE MEDICAL PRACTICE G82754DR BALDWIN A G82016DR BOWES R J & PARTNERS G82155DR CAMERON A J & PARTNERS G82733DR CHARLESWORTH J P & PARTNER G82083DR CHESOVER D F & PARTNERS G82732DR DEWING C R & PARTNER G82235DR DIGBY R J & PARTNER G82164DR DOWNING H M & PARTNERS G82605DR HINDMARSH D J G82059DR HOWITT A J & PARTNERS G82089DR JOHNSON S R & PARTNERS G82152DR LAWES M R & PARTNERS G82224DR LLEWELLYN H & PARTNER G82793DR MENNIE R H G82135DR MUSGRAVE R J & PARTNERS G82234DR PILE N R & PARTNER G82110DR RAZZELL P J & PARTNERS G82103DR SACHDEVA L G82604DR SINGH K G82215DR STREETER G S & PARTNERS G82104DR VIBHUTI R & PARTNER G82076DR WILFORD P J & PARTNERS G82112DR WINCH T & PARTNERS G82019EDENBRIDGE MEDICAL G82022GREGGS WOOD MEDICAL CENTRE G82041GROSVENOR MEDICAL CENTRE G82065GROVE PARK SURGERY G82037HILDENBOROUGH MEDICAL GROUP G82158HOWELL SURGERY G82031KING STREET SURGERY G82170LAMBERHURST SURGERY G82093LEN VALLEY PRACTICE G82768LONSDALE MEDICAL CENTRE G82681MALLING HEALTH FOUR G82030MARSHAM STREET SURGERY G82055NORTH RIDGE MEDICAL PRACTICE G82715ROWAN TREE SURGERY G82085SNODLAND MEDICAL PRACTICE G82888SOUTH PARK MEDICAL PRACTICE G82137ST ANDREWS MEDICAL CENTRE G82075ST JAMES MEDICAL CENTRE G82205ST JOHN'S MEDICAL PR G82017ST LUKES MEDICAL CENTRE G82024STOCKETT LANE SURGERY G82229SUTTON VALENCE SURGERY G82099THE COLLEGE PRACTICE G82751THE ORCHARD MEDICAL CENTRE G82691THE ORCHARD SURGERY G82125THE OTFORD MEDICAL CENTRE G82641THE SURGERY G82042TONBRIDGE MEDICAL GROUP G82200WATERINGBURY SURGERY G82092WINTERTON SURGERY G82118WOODLANDS HEALTH CENTRE G82141YALDING SURGERY

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)