'Include warfarin for AF in QOF'

The quality framework needs to include points for giving AF patients warfarin if the risk of stroke is to be reduced, a cardiovascular expert has claimed.

Dr Kathryn Griffith, a GPSI in cardiology and CHD lead for Selby and York PCT, hit back at recommendations to give AF patients aspirin with or without clopidogrel.

She told the annual Primary Care Live Conference in Docklands, East London last week: 'The quality framework has copped out by giving GPs the option of using aspirin or aspirin and the antiplatelet drug clopidogrel for preventing stroke in elderly patients.

'Instead the option of giving warfarin, which is much more effective, should be included in the quality framework.'

In the over-80s, AF has been shown to increase the risk of stroke more than four-fold.

Warfarin reduces the risk of stroke by 60 per cent, but aspirin only cuts it by 20 to 40 per cent, she explained. Clopidogrel and aspirin can also lead to bleeding problems.

Currently, the quality framework rewards GPs with 30 points, worth £3,738 to the average practice, for treating AF patients. Half of these points are earned for the ongoing management of patients with AF who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy.

GP workload for AF is set to increase because more people are living longer, said Dr Griffith.

'At the age of 55 there is a one-in-four chance that you will develop AF and 10 per cent of patients over the age of 80 will have AF.'

Professor Mike Kirby, Hertfordshire GP and member of the Primary Care Cardiova- scular Society, agreed that warfarin use should be included in the quality framework.

'Warfarin should be given to patients who are deemed to be at a high risk of suffering a stroke as indicated using the predictive tool the CHADS score,' he said. 'Those over the age of 85 should also be on warfarin.'

Warfarin is best for preventing a stroke because it stops the clotting cascade, said Professor Kirby.

'Adding warfarin use to the quality framework would help educate GPs about its use. However, most GPs are likely already to be using warfarin for high-risk AF patients,' he said.


 CHADS score
  • Congestive heart failure.
  • Hypertension (160/90mmHg).
  • Age (over 75).
  • Diabetes.
  • Stroke or TIA.

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