Increasing anticoagulant use 'better than a decade of new drugs'

A 50% rise in the number of AF patients on existing anticoagulants would have a greater impact on the nation's health than a decade of new treatment advances, a GP has said.

Warfarin: improving AF treatment would save lives (photo: Science Photo Library)
Warfarin: improving AF treatment would save lives (photo: Science Photo Library)

Too few patients with AF receive adequate anticoagulation but a relatively simple change in GP prescribing behaviour could give huge benefits to stroke prevention, according to East London GP Dr John Robson, a NICE advisor and co-author of the QRisk software.

Speaking at the NICE annual conference in Birmingham this week, Dr Robson said upwards of 80% of the one million patients with AF in the UK should be on anticoagulants.

At present, just 50-60% of AF patients are currently prescribed the drugs. In addition, 40% are taking aspirin, even though evidence shows this is ineffective.

'It's a really big issue,' he said. 'If we implemented what we already know to be effective, we would have a bigger impact on our outcomes than anything we're going to discover in the next 10 years.'

'You'll get more bang for your buck, and a bigger impact, than anything else you can do.'

NHS poor at implementing NICE advice

He cited the Anticoagulant Programme East London (APEL) initiative, an education and performance-monitoring scheme that boosted the number of patients on anticoagulants.

A recent study co-authored by Dr Robson suggested that adopting this approach nationally could reduce stroke cases by 1,600 a year.

Dr Robson also criticised the lack of a dedicated quality improvement body for issues such as this. 'I think we're missing a trick in the UK about how we implement and support translational science in a more systematic way.

'Where's the quality improvement organisations within our new organisations? Where does quality improvement lie? Is it with the CCG, is it with the academic health science networks, is it with the commissioning support units, who owns it? It's not clear.'

He called for national audits for AF, CHD, and renal disease to identify regional variation in performance.

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