PCV89 ASSESSMENT OF CARE OPPORTUNITY GAPS FOR ATRIAL FIBRILLATION IN NHS ENGLAND

Abstract

Implement the Anticoagulation Value Optimisation Tool to calculate the opportunity gaps for detection of non-valvular atrial fibrillation (AF) and anticoagulation of AF patients, and determine the level of improvement needed to meet the NHS Long Term Plan (LTP) detection target of 85%. The online tool was developed to inform Clinical Commissioning Groups (CCGs) in England about gaps in care and improve stroke prevention while optimising budget and resources and is currently populated with Quality and Outcomes Framework 2018/19 data. The care gaps addressed are the number of expected cases of AF versus the number of patients registered as having AF (detection gap) and the number of AF patients at high risk of stroke not anticoagulated (protection gap). Additional Pareto curve analysis in Excel allowed assessment of how many more cases of AF would need to be detected and treated to close these gaps by 85%. Across all 191 CCGs in England, the detection gap was 230,922 cases of AF (range 11 to 9,210 cases undetected per CCG). To achieve 85% detection, 122 of 191 CCGs would have to increase the number of AF cases identified by at least 813; eight CCGs would need to improve by more than double that number. The overall protection gap was 142,930 (range 76 to 3,960 patients per CCG not started on anticoagulants). To achieve 85% improvement, 130 of 191 CCGs would need to increase the number of anticoagulated patients by at least 474, and 15 would have to increase the number by more than twice that value. Current detection and protection gaps indicate the continued need to improve the management of AF in England and address variation. Action will be needed to achieve a sustainable diagnosis and anticoagulation service.