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Published byClara Lynch Modified over 8 years ago
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Stoke On Trent CCG – Atrial Fibrillation Service AF Nurse in GP Practice Interfacing Primary and Secondary Care for AF Stroke Prevention Jodie Williams – Atrial Fibrillation Nurse Specialist
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My Role Qualified in 2003 Acute Stroke Unit – Stroke Emergency Assessment Team
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Impact Devastation & Impact – Patients & Relatives Approx. 30% of acute stroke admissions attributable to AF
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CCG - 52 GP Practices
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Locally – Stoke on Trent Prevalence according to QOF (Jan 2013/2014) is 1.67% National Average is 1.57% Potentially underestimated by 2,800 69.6% of patients are treated with Oral Anticoagulation (OAC) Strive for 85% of high risk patients to be treated and managed effectively
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Strokes due to AF 1.5% patients in their fifties 2.8% patients in their sixties 18.8%of patients in their seventies 23.9% of patients in their eighties = approx. 140 strokes every year
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Prevention For 37 high risk patients treated with OAC we can expect to prevent one stroke in primary care If we treat 85% of high risk patients with OAC that means – 23 strokes could be prevented each year
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Cost - Locally The NICE Costing Report (2014) estimated in the first year after stroke it costs £12,244 rising to a possible £40,000 140 strokes – Local Health Economy could spend up to 5.6 million on treatment, rehabilitation and long term care Prevent 23 strokes – Potential to save £281,244 - £920,000
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AF Nurse within the CCG WHY? Improve outcomes for patients with AF Education and Support for GPs
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The Interface Primary Care Secondary Care Specialised Care
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For Each Patient…. Renal Function / Creatinine Clearence Continuation of Antiplatelets Other Medication – Herbal Remedies NSAIDS Listen to the Patient
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Where are we now? Surgery 1 1 Surgery complete – 314 patients screened 70 patients anticoagulated 37 patients awaiting review – Warfarin 27 patients – CHADSVASC = 0 4 deceased 94 Warfarin patients – TTR > 65% 5 patients on NOACS 12 patients – 24 Hour Tape 16 DNA 19 – No evidence
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Cont.… 12 patients – Bleeding risk outweighed benefit – 4 of these LAAO
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Surgery 2 28 Patients High Risk Only reviewed so far…. 119 – AF register 11 Patients Anticoagulated 6 Patients awaiting review in clinic 11 Patients no changes, refused of DNA
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A&E, AMU, MDT, Ward Referrals 40 Patients referred in total 21 Patients anticoagulated 10 Patients awaiting review in clinic 2 Patients – LAAO due to bleeding risk 7 Patients no change or DNA
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Currently 102 / 382 Patients have been managed and commenced on anticoagulation and effectively managed
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This means… A potential of 3 major strokes have been prevented Potential cost saving between £ 35,700 - £132,000
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Trajectory If in 12 months we can appropriately anticoagulate 370 AF patients – We can prevent 10 major strokes Potential cost saving of a minimum of £122,440 - £400,000 Not to mention a reduction in patient suffering and carer burden
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Positives Reduced Patient / Carer Burden, Cost Effective Passion and Dedication as a Team Education and support for GP’s and the Public Public Awareness
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Negatives Detection and awareness An Improved trajectory Reluctance and trust in prescribing Public awareness – Cost, Reluctance
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Thank you!!
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