Stroke risk associated with atrial fibrillation can be significantly reduced by appropriate preventative action. However, NICE estimate that 46% of patients who should be anticoagulated are not. The PCAF service is a pathway that provides expert resources within GP practices with the aim of improving anticoagulation among high-risk patients. To date, 42 GP practices have been enrolled, covering a population of 284,945. A total of 761 patients attending for review had anticoagulation offered, of whom 745 agreed. It is estimated about 30 strokes have been prevented.
Atrial fibrillation (AF) is a major risk factor for stroke. The risk of stroke can be significantly reduced by appropriate thromboembolic prophylaxis, and the recent release of three novel oral anticoagulant agents (NOACs) has expanded the therapeutic options. Despite this, the National Institute for Health and Care Excellence (NICE) estimates that 46 per cent of patients that should be anticoagulated are not.
A new approach was therefore needed. Hospital clinicians dealing regularly with AF and stroke patients are best-placed to initiate anticoagulation and to understand the therapeutic options, but the majority of these patients are not under review in secondary care. Secondary care expertise needed to be extended to the primary care setting.
The primary objective of the Primary Care Atrial Fibrillation (PCAF) service is to utilise expert resources to improve the uptake of anticoagulation in AF patients at high risk of stroke within the primary care setting. To do so, a series goals needed to be met within each enrolled GP practice.
These included improving the accuracy of the practice AF register, to include all high-risk patients, assessing stroke risk in all AF patients, and identifying those with an elevated stroke risk. Other goals were to improve the invitation of patients for clinical review regarding anticoagulation, with as minimal a non-attendance rate as possible, and to provide consultant-led anticoagulation assessment clinics within the patients’ GP practice.
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