General practice AF scheme could prevent 1,600 strokes a year

Around 1,600 strokes a year could be prevented if an East London programme that encouraged GPs to prescribe anticoagulants to more AF patients was rolled out across the UK, research suggests.

Warfarin: scheme improved anticoagulation treatment (photo: Science Photo Library)
Warfarin: scheme improved anticoagulation treatment (photo: Science Photo Library)

The Anticoagulant Programme East London (APEL) initiative boosted the number of at-risk patients on anticoagulants and almost doubled the number of new patients on AF registers in just two years.

The programme, which ran across three PCTs between 2011 and 2013, combined education around NICE guidelines, computer prompts to assist decision-making, and patient review and feedback of results.

Researchers from the Queen Mary University of London, who studied the scheme, said adopting it nationally to benefit the 1m AF patients known to general practice could reduce stroke cases by 1,600 a year.

This could also prevent a further 200 patients a year developing heavy bleeding, by reducing inappropriate aspirin use.

The APEL system costs around £300 per surgery for the first two years, and just £100 annually to maintain after that, a figure that is ‘modest in comparison to the cost of not taking action,’ said study authors.

Five-fold increase

Their research looked at the records of 4,604 AF patients across the inner London PCTs of Tower Hamlets, Newham, and City and Hackney between April 2011 and 2013.

Adoption of APEL increased the proportion of people with a CHA2DS2-VASc score of ≥1 on anticoagulants from 52.6% to 59.8% over two years, a rise of 7.2 percentage points.

This compares with a rise of just 2.2 percentage points over the previous three years, suggesting APEL led to a five-fold increase in the rate of improvement.

In contrast, the proportion of these patients on aspirin declined from 37.7% to 30.3%. The number of new entrants to AF registers rose from 108 to 204.

Study authors said although APEL was more effective than current approaches, the proportion of untreated AF patients remained high, with ‘considerable variability’ between practices.

They said: ‘Additional investment by CCGs in supportive programmes is required to increase the slope of improvement and attain 80% levels of anticoagulation without inappropriate delay.’

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