Stop a Stroke - Why?

Stroke Facts

Atrial fibrillation is the most common sustained cardiac arrhythmia and a significant risk factor for stroke.
The average cost of care (acute and rehabilitation) per stroke patient is currently £23 315 [1].
Only 1/3 of people who have AF-related stroke have been treated with anticoagulants [4].
The management of AF in UK Primary Care presents a resource challenge that is set to rise as our population ages [3].

Did you know...

7422 people suffered a stroke in Wales in 2014-2015 [1].
The average age of someone suffering from a stroke in Wales is 42 [1].
Atrial fibrillation is a contributing factor to 20% of strokes in Engalnd, Wales and Northern Ireland [1].
Only 4 in 10 stroke patients with known atrial fibrillation (AF) are on anticoagulant treatment on admission to hospital in England, Wales and Northern Ireland [1].
Increasing the proportion of people with AF on anticoagulants will reduce the number of people having a stroke [5].
NICE Quality Standard 93 states that adults with non-valvular atrial fibrillation with a CHA₂DS₂-VAS_c stroke risk score of greater than 1 in men or 2 in women should be considered for anticoagulation and patients should not be on aspirin monotherapy for stroke prevention if this is the sole indication [2].

In June 2014, the National Institute for Health and Care Excellence (NICE) published Clinical Guideline 180 “AF: management” its aim was to “ensure that people receive the best management to help prevent harmful complications, in particular stroke and bleeding” In addition the NHS operating framework prioritised AF and stroke prevention as key areas for maintaining healthcare quality and improvements. A key feature of both is the early identification of patients at risk of thromboembolic events and the prompt initiation of an oral anticoagulant as this has been shown to reduce the risk of stroke by 2/3. These recommendations were supported by AWMSG and endorsed by Welsh Government.

The data suggest that 40% of patients with atrial fibrillation within C&V who are not on the appropriate treatment can be anticoagulated. In C&V, 2300 AF patients will not be on anticoagulation. If 920 patients (40%) are anticoagulated, the stroke risk per year will fall from 10% to 3%, which will prevent 65 stroke per year. This would be a potential 10% reduction in all strokes.

No guidance on how to achieve this treatment switch has previously been previously been produced. This project aims to fill that gap in order to support the delivery of the 10% reduction in all strokes

References

Stroke Association, State of the Nation Stroke Statistics January 2016. Available via: https://www.stroke.org.uk/sites/default/files/stroke_statistics_2015.pdf Accessed on 15/06/16.
Atrial Fibrillation. NICE Quality Standard QS93, July 2015. Accessed via: https://www.nice.org.uk/guidance/qs93 Accessed on 15/06/16.
Managing atrial fibrillation in Primary Care: key issues for Primary Care practitioners, managers and commissioners of service, 2015. Accessed via https://www.bhf.org.uk/healthcare-professionals/best-practice/managing-atrial-fibrillation-in-primary-care Accessed on 05/09/16.
https://www.bhf.org.uk/healthcare-professionals/best-practice/managing-atrial-fibrillation-in-primary-care/af-and-stroke---we-can-do-better Accessed 09/01/2017.
Together for Health. Stroke Annual Report 2016. Accessed via: http://gov.wales/docs/dhss/publications/161128stroke-reporten.pdf on 09/01/2017.