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AF180 | Key responsibilities on atrial fibrillation related stroke

INDIVIDUALS, CARERS OR FAMILY MEMBERS

AS AN INDIVIDUAL WITH AF OR THEIR CARER OR FAMILY MEMBER, I WILL…

Not be afraid of asking questions that may help my understanding of AF and AF-related stroke

    • The best patient care happens when there has been truly shared decision making. Patients need to have the educational tools available to ensure that they can ask questions and make informed decisions about their anticoagulation therapy. This will help to support compliance with their chosen treatment option.
    • Patients, carers and family members should challenge doctors to explain the condition and the associated risks in language that they understand.

          MEMBERS OF THE GENERAL PUBLIC

          AS A MEMBER OF THE GENERAL PUBLIC, I WILL…

          Learn more about manual pulse checks in order to help more individuals to be diagnosed with AF

            • Members of the public should be encouraged to find out how to undertake their own pulse checks or support family members to take their pulse.
            • This could be achieved through public awareness campaigns, such as Know Your Pulse.

                  MEMBERS OF THE HEALTHCARE TEAM

                  AS A MEMBER OF THE HEALTHCARE TEAM, I WILL...

                  Make every contact count

                    • Improved identification of patients with AF through opportunistic manual pulse checks across all clinical settings may enable more people to have their AF-related stroke risk appropriately managed.
                    • Clinical settings should also make use of the available small scale and innovative technology that supports identification of AF, such as smartphone applications.

                  Act with appropriate urgency when a diagnosis of AF has been given

                    • Patients with AF who are not receiving appropriate anticoagulation for their individual stroke risk are at risk of an AF-related stroke at any time, with potentially devastating consequences for these patients and their families and carers.
                    • Initiation onto any treatment should only occur when all options have been discussed with the patient and the choice has been based on the clinical features of the options and the patient’s and preferences.

                  Communicate clearly about AF and AF-related stroke prevention in a way that is helpful to patients

                    • Healthcare professionals need to receive more training and education to enable them to feel confident talking to patients with AF about their stroke risk and bleeding risk and to answer any questions that these patients may have. Resources are available such as the NICE Atrial Fibrillation Patient Decision Aid and via the Don’t Wait to Anticoagulate website to assist healthcare professionals in communicating with patients about their individualised risk.
                    • It is important that patients feel informed, educated and reassured when initiated onto the appropriate anticoagulation to help them understand the need for continued adherence to their treatment..
                    • It is important that follow-up appointments are used as opportunities to check patients’ understanding of their condition and to reinforce the importance of anticoagulation therapy in managing their risk of AF-related stroke.

                  Communicate with patients about the inappropriate use of aspirin in AF-related stroke prevention.

                    • Far too many patients are still on aspirin alone, rather than an oral anticoagulant to reduce their individual risk of AF-related stroke. Healthcare professionals need more training and support on how to have a responsible conversation about aspirin with their patients with AF, to ensure their patients understand aspirin alone is no longer considered to be appropriate for the prevention of AF-related stroke.
                    • Whilst we recognise that some AF patients may be taking aspirin for other health conditions, many are likely to have been prescribed aspirin solely for AF-related stroke prevention).

                    ALL INDIVIDUALS INVOLVED IN SERVICE PLANNING

                    WHEN PLANNING AND MANAGING AF-RELATED PREVENTION SERVICES, I WILL…

                    Improve pathways of care to optimise local management of AF-related stroke prevention

                      • There is variation across the country in some GPs’ experience of anticoagulation for AF-related stroke prevention.
                      • It could be helpful for some GPs to have support from secondary care stroke specialists in managing AF-related stroke prevention. For example, some areas could look at providing a dedicated phone line for GPs to ask secondary care clinicians questions about anticoagulation for AF-related stroke prevention.
                      • There also needs to be far more joined up and integrated patient pathways between primary and secondary care, especially once a patient has had an AF-related stroke and has been discharged back into the community.

                    Ensure that incident reviews are conducted on any potentially avoidable AF-related strokes that occur

                      • Should an AF-related stroke take place, this should be followed back through the health system via root cause analysis to identify whether this was potentially avoidable (i.e. was the patient receiving appropriate anticoagulation and being supported to manage their AF and risk of AF-related stroke?).
                      • All healthcare professionals involved in the individual’s care should be made aware of the review’s findings.

                    Communicate to CCGs and individual GP practices how their performance compares locally and nationally

                      • Local performance data (that are readily accessible from the annual Quality Outcomes Framework database) should be made publicly available to help hold NHS organisations to account but also to help them to understand how they are performing and the areas in which they could improve. CCGs will need to proactively offer support to under-performing practices.
                      • It is also unacceptable that patients with AF should experience long waiting times for appointments with anticoagulation clinics and therefore delayed initiation onto treatment, particularly when newer treatments available for certain types of AF can be initiated by GPs immediately

                    Showcase and learn from best practice to support peer to peer learning

                      • Across England, there are fantastic examples of local activity which are improving patient outcomes but these are not always shared more widely within the region or nationally.
                      • One example of where best practice case studies have been shared is the 2015 Healthcare Pioneers report, developed by the AF Association and the All-Party Parliamentary Group on Atrial Fibrillation (APGAF), which identifies best practice across England and Wales in the diagnosis, treatment and care of patients with AF.