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How our CCG identified 500 people with new atrial fibrillation

How our CCG identified 500 people with new atrial fibrillation

Dorset Clinical Commissioning Group (CCG) saw an opportunity to identify people over the age of 65 with new atrial fibrillation (AF). The CCG was announced as one of the AF Association Healthcare Pioneers 2018 – Showcasing Best Practice in AF winners for its project.
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Dorset Clinical Commissioning Group (CCG) saw an opportunity to identify people over the age of 65 with new atrial fibrillation (AF).

The CCG was announced as one of the AF Association Healthcare Pioneers 2018 – Showcasing Best Practice in AF winners for its project.

The problem

AF is a heart condition that causes an irregular heart rhythm and can lead to a stroke. It is the most common type of arrhythmia.

Every 15 seconds, someone suffers an AF-related stroke, yet most can be prevented using appropriate anticoagulation therapy.

With a population of over 750,000, which includes 187,456 over 65-year olds, we have a higher prevalence of AF at 2.68% compared to the national prevalence of 1.91%.

What we did

We embarked on a four-year project to opportunistically screen and identify people over the age of 65 with AF.

Those patients were offered a pulse check whilst attending flu vaccination clinics.

If an irregular pulse was detected, an electrocardiogram (ECG) was performed to ascertain the type of arrhythmia so appropriate treatment could begin.

Challenges

The original proposed pathway assigned healthcare assistants to take pulses during flu clinics.

But as a consequence of the pilot project, we agreed that it’s more appropriate for GPs, nurse practitioners and practice nurses to carry out the pulse checks to ensure healthcare professionals with the required competencies were able to identify irregular pulses. 

A centralised ECG clinic for the locality was suggested at the planning stage of the pilot to enable larger practices to accommodate their potentially greater number of patients.

However, we realised that information governance legislation would restrict this from taking place. In addition, it was highlighted that people may become anxious attending a clinic at different premises rather than their GP practice to have an ECG.

As a result, practices held ECG clinics in house and patients were invited to make an appointment within the week.

Patient evaluation survey was sent to practices to forward to people who had their pulse taken at the flu clinic and were identified with an irregular pulse.

These were meant to be sent only to newly diagnosed patients at the time of receiving a flu injection.

But some of the practices sent evaluations to patients who already had a diagnosis of an irregular pulse and/or AF, which resulted in some confusion amongst those patients who were asked to complete the evaluation.

Another challenge was that patient who were informed prior to having their flu injection that they were going to have their pulse taken were more satisfied than people who had unexpected screening. 

Approximately 65% of the patients who returned their evaluation survey didn’t receive notification that pulses would be taken.

The last challenge we face was that a significant proportion of patients reported they had to wait over five days for their ECG appointment – one patient waited for 13 days, instead of receiving it on the same day as the pulse check.

Results

We had 65% of the 98 Practices in Dorset undertaking the initiative in 2016-17, which resulted in 60,634 patients aged 65 or over receiving a manual pulse check.

Of these, 2,514 patients were referred for an ECG at which 469 new patients were diagnosed with AF.

The future

The service will continue to be offered under the Prevention at Scale element of the Dorset sustainability and transformation partnership (STP) model of care.

It has been offered to 100% of practices within Dorset as a Local Enhanced Service (LES), with 83 of the 86 practices signed up to deliver within 2017-18.

CCG comment

‘This project is an excellent example of how health partners can work together to identify health conditions in those people who may not regularly use services and not be aware they could be at risk.

‘Since we launched the project, we have seen nearly 1,300 people diagnosed with AF, meaning we are able to support them in reducing their personal risk and ultimately save lives.

‘We are thrilled with the award and I would like to thank all my colleagues in GP practices across the county who have taken part in the project to date.’

Nichola Arathoon is the principal programme lead at Dorset CCG

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