1. 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

2. My Role Qualified in 2003 Acute Stroke Unit – Stroke Emergency Assessment Team

3. Impact Devastation & Impact – Patients & Relatives Approx. 30% of acute stroke admissions attributable to AF

4. CCG - 52 GP Practices

5. 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

6. 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

7. 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

8. 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

9. AF Nurse within the CCG WHY? Improve outcomes for patients with AF Education and Support for GPs

10. The Interface Primary Care Secondary Care Specialised Care

11. For Each Patient…. Renal Function / Creatinine Clearence Continuation of Antiplatelets Other Medication – Herbal Remedies NSAIDS Listen to the Patient

12. 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

13. Cont.… 12 patients – Bleeding risk outweighed benefit – 4 of these LAAO

14. 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

15. 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

17. Currently 102 / 382 Patients have been managed and commenced on anticoagulation and effectively managed

18. This means… A potential of 3 major strokes have been prevented Potential cost saving between £ 35,700 - £132,000

19. 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

20. Positives Reduced Patient / Carer Burden, Cost Effective Passion and Dedication as a Team Education and support for GP’s and the Public Public Awareness

21. Negatives Detection and awareness An Improved trajectory Reluctance and trust in prescribing Public awareness – Cost, Reluctance

22. Thank you!!