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Atrial Fibrillation – identification and treatment

This project is likely to take:
<10 hours for the initial project (excluding re-audit)
<10 hours in total (including re-audit)

This project is best carried out by a GP (qualified or trainee), a nurse or other allied healthcare professional

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

  • Safe-Medicine Optimisation
  • Effective -Evidenced Based Care 

On this page

The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Increased AF diagnosis preventing future ill health
  • Increase in healthy lifestyle education resulting in healthier lifestyles
  • Increase in AF treatment 
  • Reduced CVAs 
Project benefits for Your Practice

Benefits for Your Practice

  • Preventing future ill health 
  • Preventing future workload from post-CVA patients 
  • Increased QoF income 
  • Prescribing of better value DOACs if appropriate 
Project benefits for The Planet

Benefits for The Planet

  • Healthier lifestyles leads to an increase in active travel and reduction in air pollution, healthier diets with more plant-based options and a reduction in patients with CVAs leading to reduced prescribing and increased independence.

Opportunity for improvement

  • Identification and treatment of atrial fibrillation (AF) is one of the 16 areas chosen for Integrated Care Board (ICB) National Medicines Optimisation.
  • An estimated 1.5 million people in England have AF, but only 1.3 million patients are recorded on GP registers as having AF, with an estimate of several hundred thousand people yet to be identified. AF contributes to around 1 in 5 cerebrovascular accidents (CVA). If a patient with AF is at high risk of CVA, anticoagulant medication may reduce this risk by preventing a blood clot.  
  • NHS England’s commissioning recommendations for the national procurement of direct acting oral anticoagulants (DOACs) outlines the best value treatment choices to maximise affordability and support treatment for the greatest number of patients. Where clinically appropriate, prescribers should aim to utilise the best value DOACs considering local guidelines and other clinical factors (eg. Apixaban 5mg bd if high risk of GI bleed, or Rivaroxaban 20mg od if BMI >120Kg). AF008 is a QOF indicator which encourages anticoagulation for patients with AF, if appropriate, with a DOAC as first line treatment.   
  • As the AF toolkit says, we therefore need to ‘detect’ AF, ‘protect’ the patient by offering anticoagulation (if appropriate eg. check CHA2DS2-VASc and ORBIT score), and ‘perfect’ their doses so their treatment is optimised. If a patient is found to have AF, it is also essential to offer and encourage ongoing lifestyle advice to enable the patient to optimise their health and reduce risk of further complications in the long term as these are also important to reduce their CVA risks. 
  • Here are some resources that can help with increasing uptake of AF detection and treatments:  
  • CVD PREVENT Atrial Fibrillation indicators, updated quarterly
  • Atrial fibrillation: diagnosis and management, NICE CKS  
  • Include this sentence:  This project aims to increase the identification of atrial fibrillation for your patients aged over 64 (see disclaimers). 
  • You might like to create a SMART goal for this project e.g.,for at least 50% of your >65 years olds to have had a pulse check added into their medical records in the previous 12 months.  

How to carry out this project

  1. Hold a meeting in the practice with the clinicians to discuss what will work best in your practice to detect and initiate treatment of patients with AF (it can be a combination of these or all of them): 

    • Agree a blanket policy to check the pulse of every patient aged over 64 who is having a flu vaccine, blood pressure check or who is having a F2F appointment.
    • Search for patients aged 64 and over who have not had a pulse check in the past year. Add a pop up to the computer so clinicians are alerted to opportunistically check the patient’s pulse if they consult (arrange an ECG to confirm AF if an irregular pulse is discovered). We hope to provide downloadable IT searches for EMIS & SystmOne soon.  In the meantime, you could use Arden’s ‘AF – screening eligible population’ search in ‘Conditions | Cardiovascular | Registers’ and link it to a search for ‘all patients who are over 64 years old’ and exclude patients in the search ‘Subreport | Observations | Pulse rhythm monitored in last 13m’. 
    • Search for the missing patients on your QoF AF register who are not anticoagulated but whose CHA2DS2-VASc score is >=2 (arrange an appointment with your practice pharmacist to check the ORBIT score and discuss DOAC initiation)  
    • Search your AF register to make sure all the patients have an annual review to check their CHA2DS2-VASc and ORBIT score to see if anticoagulation should be started if not already taking, stopped or changed to a better value DOAC 

  2. Post Intervention data collection

    Re-run any of the above audits you have chosen to run monthly, or quarterly to review what improvements your QIP has made to you’re the number of patients in each chosen audit. Use the Project Monitoring form to keep track.

  3. Please link this QIP with the Birthday Month QIP so that any monitoring test for DOACs started will align with their other long-term conditions to reduce combine tests and review appointments. Lifestyle advice given can include the NHS’s Better health website.

Top tip

If your practice uses birthday month recalls, you can stratify your patient search list into their month of birth to make sure you are not contacting patients ahead of their birthday month.

How to scale this project up or down

Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.

Share your project with your PCN, Federation, ICB (England) or Cluster, Health Board (Scotland or Wales) or GP federation, Health Trust (Northern Ireland), to encourage them to set up a local scheme to increase the number of patients with AF who are identified and initiated on treatment, where clinically appropriate. This way the learning can be shared and the project easily implemented by other practices too.   

Have you completed this QIP?

Tell us a little about your project and enter your data in order to generate a certificate showing the probable benefits. This project may help with CQC evidence submission (see disclaimers). 

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