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Atrial fibrillation

Pharmacists to identify AF patients at risk of stroke in £9m NHS England programme

Following a successful pilot scheme in south London, specialist pharmacists will soon help identify patients who are at risk of atrial fibrillation across 23 areas in England.

Specialist pharmacists across 23 areas in England will help to identify patients who have atrial fibrillation (AF) and are at risk of stroke and could benefit from anticoagulant medication, under a £9m programme announced by NHS England.

Anyone identified as being at risk will be offered a personalised treatment plan, developed in partnership with their GP.

It is hoped that the scheme, which will run until March 2020, will help around 20,000 people at a higher risk of stroke receive targeted checks and treatment from specialist pharmacists and nurses. The programme forms part of the NHS’s focus on tackling major diseases, including heart disease, cancer and diabetes, as set out in the ‘NHS Long Term Plan’.

NHS England said that treating people who have AF with anticoagulation drugs reduces the risk of stroke by two-thirds, yet only half of those with the condition who go on to have a stroke had been prescribed them.

The new programme is based on a pharmacist-led ‘virtual clinic’ pilot in south London, which aimed to identify and review all patients who have AF who had not yet received anticoagulation treatment.

The in-practice virtual clinics, so named because the patient is not present, provided an opportunity for GP practice staff to discuss anticoagulant options with specialist pharmacists and develop individualised patient management plans to ensure that their AF was being managed as effectively as possible.

Under the 12-month scheme across Lambeth and Southwark clinical commissioning groups (CCGs), 1,574 patients who have AF not currently receiving anticoagulation were reviewed and, as a result, 1,292 additional patients were anticoagulated.

The two CCGs have since experienced a 25% reduction in the rate of AF-related stroke.

“As a result of the virtual clinics delivered across Lambeth and Southwark CCGs, we have seen a substantial increase in the number of patients who have AF who are prescribed anticoagulant therapy, and an associated reduction in AF-related strokes,” said Helen Williams, consultant pharmacist for cardiovascular disease (CVD) at Southwark CCG and clinical network lead for CVD at Lambeth CCG. 

“We are delighted that NHS England is investing in rolling out this model to a further 23 CCGs so that more patients across the country can benefit.”

The CCGs to receive funding are in areas of the country with high levels of deprivation and/or high levels of untreated AF.

Matt Kearney, national clinical director for cardiovascular disease prevention at NHS England, said that targeting help at those groups most at risk would be a “life saver”.

“Making effective treatment available and expanding access to care across England will mean GPs and pharmacists can offer support and prevent death and long-lasting harm.” 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206509

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