requesting information regarding atrial fibrillation in NHS West Kent Clinical Commissioning Group

Transcription

1 NHS Wet Kent Clinical Commiioning Group October 2015 Our Ref: FOI.15.WK0138 requeting information regarding atrial fibrillation in NHS Wet Kent Clinical Commiioning Group Pleae find attached a Freedom of Information requet on the ubject of atrial fibrillation. Pleae find attached: 1) Your completed urvey, alo hown a Appendix A at the end of thi letter 2) Primary care atrial fibrillation pathway A COPY OF THE PRIMARY CARE ATRIAL FIBRILLATION PATHWAY IS AVAILABLE UPON REQUEST

2 Appendix A Atrial Fibrillation in Your Area Quetion 1: Between 1 July 2014 and 30 June 2015, in the area covered by your CCG: a) What wa the prevalence of atrial fibrillation (AF)? I can confirm NHS Wet Kent Clinical Commiioning Group (CCG) may hold thi information. However, NHS Wet Kent CCG conider thi information i exempt under ection 21 of the Act a the information i reaonably acceible to the Applicant by another route. The information i publihed within the Public Health Obervatory webite, available on the following link: b) How many patient were diagnoed with AF? During the period requeted, 59 patient were referred to the Primary Care Cardiology ervice. However, patient can alo be diagnoed within econdary care to acce thi information you may wih to contact NHS Wet Kent CCG main acute provider, Maidtone and Tunbridge Well NHS Trut (MTW). They can be contacted at: MTW-TR.FOIadmin@nh.net c) How many patient received a manual pule check for AF? GP are encouraged to undertake opportunitic teting on patient a they preent. Some practice carry out thee check during flu clinic, for example. However, NHS Wet Kent CCG doe not hold exact number a it would be difficult to quantify. Quetion 2: Which of the criteria lited below i included in the peronalied package of care offered to patient with AF? (Pleae tick the boxe that apply) I can confirm that NHS Wet Kent CCG doe not hold thi information. All patient care i individualied, however ome may be managed by the GP and Practice Nure, and other will be referred on to an acute trut for management by a cardiologit. NHS Wet Kent Clinical Commiioning Group

3 Peronalied Package of Care and Information NICE Clinical Guideline 180 Atrial Fibrillation: the management of atrial fibrillation make the following recommendation on offering patient with AF a peronalied package of care: Offer people with atrial fibrillation a peronalied package of care. Enure that the package of care i documented and delivered, and that it cover: - AF-related troke awarene and meaure to prevent AF-related troke - rate control - aement of ymptom for rhythm control - who to contact for advice if needed - pychological upport if needed - up-to-date and comprehenive education and information on: caue, effect and poible complication of atrial fibrillation management of rate and rhythm control anticoagulation; practical advice on anticoagulation in line with recommendation in 'Venou thromboembolic dieae' (NICE clinical guideline 144) upport network (for example, cardiovacular charitie). Quetion 3: What tep doe your CCG take to verify that patient with AF are being offered a peronalied package of care? I can confirm that NHS Wet Kent CCG doe not currently have any proce in place to verify that patient with AF are being offered a peronalied package of care. However, in September 2015 the CCG implemented a Local Incentive Scheme for practice which focue on increaing anticoagulation in patient diagnoed with AF. The overall ambition i to increae the rate of anticoagulation, reducing the number of troke econdary to AF. Quetion 4: What upport network and information are advertied and provided to patient with AF? I can confirm that NHS Wet Kent CCG doe not currently have any proce in place with regard to upport network or information provided to patient with AF. However, the topic of AF i frequently included on the agenda at GP education event and we are alo undertaking an audit of AF from the GRASP-AF Local Incentive Scheme (a mentioned above). NHS Wet Kent Clinical Commiioning Group

4 Quetion 5: Between 1 July 2014 and 30 June 2015, how many patient in the area covered by your CCG have been referred for pecialied management due to: a.) Failure of AF treatment to control the ymptom of AF? b.) Recurrence of AF following cardioverion? NHS Wet Kent CCG doe not hold thi information. Maidtone and Tunbridge Well NHS Trut (MTW) provide thi ervice o you may wih to redirect your requet to MTW, who can be contacted on the following detail: MTW-TR.FOIadmin@nh.net Pleae alo be aware that patient within the NHS Wet Kent CCG area may alo be treated in London hopital by other provider. Referral for Specialied Management NICE Clinical Guideline 180 make the following recommendation regarding referral for pecialied management: Refer people promptly at any tage if treatment fail to control the ymptom of atrial fibrillation and more pecialied management i needed. Quetion 6: What tep do your provider take to enure that people with any of the above condition are aeed for AF-related troke rik uing the CHA2DS2-VASc troke rik core? A part of the GP Local Incentive Scheme, practice within NHS Wet Kent CCG are running the GRASP-AF audit tool to detect patient (with AF) with a CHA2DS2-VASc core of >1 and are not anticoagulated. Aement of Stroke and Bleeding Rik NICE Clinical Guideline 180 make the following recommendation regarding aement of AF- related troke rik: AF- Related Stroke rik Ue the CHA2DS2-VASc troke rik core to ae AF-related troke rik in people with any of the following: - ymptomatic or aymptomatic paroxymal, peritent or permanent atrial fibrillation - atrial flutter a continuing rik of arrhythmia recurrence after cardioverion back to inu rhythm. Quetion 7: What tep do your provider take to enure that the HAS-BLED core i ued to ae the rik of bleeding in people who are tarting or have tarted anticoagulation? The ue of the HAS-BLED core i included in the NHS Wet Kent CCG Primary Care Atrial Fibrillation Pathway (ee attached). NHS Wet Kent Clinical Commiioning Group

5 NICE Clinical Guideline 180 make the following recommendation regarding aement of bleeding rik: Bleeding rik Ue the HAS-BLED core to ae the rik of bleeding in people who are tarting or have tarted anticoagulation. Offer modification and monitoring of the following rik factor: - uncontrolled hypertenion - poor control of international normalied ratio (INR) ('labile INR') - concurrent medication, for example concomitant ue of apirin or a non-teroidal anti-inflammatory drug (NSAID) - harmful alcohol conumption. Quetion 8: Of the patient who were treated for AF in the area covered by your CCG between 1 July 2014 and 30 June 2015, how many had a CHA2DS2-VASc core of 2 or above? NHS Wet Kent CCG doe not hold thi information. Intervention to prevent troke NICE Clinical Guideline 180 make the following recommendation regarding intervention to prevent AF-related troke: Anticoagulation Anticoagulation may be with apixaban, dabigatran etexilate, rivaroxaban, edoxaban or a vitamin K antagonit. Offer anticoagulation to people with a CHA2DS2-VASc core of 2 or above, taking bleeding rik into account. Quetion 9: Of thee patient, how many were treated for AF-related troke prevention with: a.) Anticoagulation therapy (therapy which reduce the body ability to form clot in the blood)? NHS Wet Kent CCG doe not hold thi information. b.) Apirin monotherapy (the treatment of AF with apirin alone)? NHS Wet Kent CCG doe not hold thi information. However, the CCG doe not recommend apirin monotherapy, although the treatment of all patient i individualied to their need. NHS Wet Kent Clinical Commiioning Group

6 Quetion 10: What guidance do you give to your provider to enure they are precribing an appropriate anticoagulant approved by NICE for AF-related troke prevention rather than apirin monotherapy? I can confirm NHS Wet Kent CCG doe hold the information you requeted. The CCG conider that thi information i exempt under ection 21 of the Act a the information i reaonably acceible to the Applicant by another route. The information i publihed within a joint webite by NHS Wet Kent CCG and MTW, and can be found under Therapeutic Section > 2. Cardiovacular Sytem > Oral anticoagulant. The information you requeted i alo available on the following link: Quetion 11: Of the patient treated with anticoagulation therapy for AF-related troke prevention in the area covered by your CCG between 1 July 2014 and 30 June 2015, what percentage were treated with: a.) A novel oral anticoagulant (NOAC)? b.) Warfarin? NICE Clinical Guideline 180 make the following recommendation regarding ue of antiplatelet: Antiplatelet Do not offer apirin monotherapy olely for troke prevention to people with atrial fibrillation. I can confirm NHS Wet Kent CCG doe not hold thi information. NHS Wet Kent CCG hold information on medication unit precribed but patient diagnoi i recorded within individual health record; therefore they would be unable to etablih if a pecific medication ha been precribed to treat a pecific condition. Information on precribing data i available in the public domain; you may wih to try earching within the NHS Buine Service Authority (NHSBSA) Information Service Portal, via the Guet Login. Once on the webpage you can acce the information by clicking on the +Data icon at the top left ide of the webpage, next chooing the Precribing Data option and finally chooing the Detailed Precribing Information option. Another option would be to acce the Health and Social Care Information Centre (HSCIC) on the following link: Search?q=gp+practice+precribing+preentation&go=Go&area=both A the GP practice may hold the information you have requeted in thi quetion; you may wih to redirect thi part of your requet to them. A lit of all NHS Wet Kent CCG GP practice can be found on their webite, acceible on the following link: NHS Wet Kent Clinical Commiioning Group

7 Quetion 12: Do your provider offer rate-control a the firt-line trategy to patient with AF? *AF i aociated with an increaed heart rate, which can caue both immediate and long term health conequence. Rate control ue drug approved by NICE or urgical intervention to reduce the ventricular heart rate, and thereby improve ymptom and reduce the rik of aociated morbidity. Rate and rhythm control NICE Clinical Guideline 180 make the following recommendation regarding rate and rhythm control: Offer rate control* a the firt-line trategy to people with atrial fibrillation, except in people: - whoe atrial fibrillation ha a reverible caue - who have heart failure thought to be primarily caued by atrial fibrillation - with new-onet atrial fibrillation - with atrial flutter whoe condition i conidered uitable for an ablation trategy to retore inu rhythm for whom a rhythm control trategy would be more uitable baed on clinical judgement. NHS Wet Kent CCG ue the attached pathway which give guidance to clinician on which approach to take, rate or rhythm control. A per the protocol mot patient will fall under the rate control approach. NHS Wet Kent Clinical Commiioning Group