1. NHS REDBRIDGE ILFORD LIST SIZE 4500, INDO-ASIAN 90%, PREVALENCE OF DIABETES 9%, CHD 4%, AF <65yr-0.5%, ≥ 65yr-4.3%

3. Cranbrook PolysystemJuly 2010 CHADS₂ >1Not on Warfarin 76 125 5027 85 107 168 125 115 1611 Total 14279 3

4. BARRIERS TO OAC & AF Primary Care :  Lack of Diagnostics ECG, HOLTER, ECHO  Lack of access for advice for starting OAC  Its too complicated  It’s not my job ! (some GPs refuse to prescribe OAC)  Don’t understand - what is CHADS ?  Lack of incentive - money for pulse check  Monitoring is too difficult ! For whom ?

5. Secondary Care Diagnosis – AF not significant, “For Warfarin”– “No Warfarin” “Grey area” Patients Warfarin is dangerous, high bleeding risk, is it? Patients don’t like Warfarin! Is that true?

6. SCREENING FOR AF FLU CLINIC (PULSE CHECK) OPPORTUNISTIC SCREENING – CO-MORBIDITIES IHD, HYPERTHYROID, POAF, ASD, STRUCTURAL HD, OSA, HF ANNUAL PLUSE CHECKS FOR BP & T2DM TARGETED SCREENING OF OLDER AGE GROUPS LOCAL AF PATIENT SUPPORT GROUPS 6

7. COMMISSIONING INTEGRATED CARE - PRIMARY/SECONDARY GRASP-AF TOOL ACROSS THE SECTOR (LES in NHSR) EDUCATION PRIMARY CARE -- PLT ACCESS TO DIAGNOSTICS IN PRIMARY CARE ONE STOP CLINICS in PRIMARY CARE ANTI-COAGULANT CLINIC IN PRIMARY CARE NEW QOF FOR AF NEW OAC THERAPIES IMPROVED OUTCOMES 7

8. AF PREVENTION Challenge : London to Paris Summer 2011

9. Community AF Clinic Borough of Waltham Forest Based in Primary Care Health Centre Closer to home patient care One stop clinic for diagnosis & treatment OAC decision making Specialist advice Prof R Schilling Pulse check clinics

10. AF Register QOF AF prevalence for WF 0.7% OAC <50% in patients with CHA 2 DS 2 -VASc≥1 Incorrect coding/diagnosis 10% Patients for OAC about 33%

11. SUGGESTIONS Secondary care better documentation & reporting: diagnosis of AF (add to register) Improve awareness in secondary care of issues in Primary care Better training of Primary Care staff regarding coding and summarisation

12. DIFFICULTIES FOR GRASP-AF Different IT systems in Primary Care QOF deadline: practices not engaging GP education- to improve interest ?? LES