Overview

NEW DWAC logoThe West of England AHSN, working in collaboration with Bayer Healthcare, has developed an innovative project to help prevent strokes amongst patients with atrial fibrillation (AF), which has gained national recognition and is now being adopted by 13 AHSNs around the country.

During the 24 weeks of phases one and two of the project’s roll-out in the Westcountry, Don’t Wait to Anticoagulate (DWAC) has potentially prevented 21 strokes amongst people with AF, representing a saving of over £489,000, by optimising medicines management in primary care.

People with atrial fibrillation (AF) are five-times more likely to suffer a stroke than people with a normal heart rhythm, and AF causes one in five of all strokes. People who suffer this type of stroke are less likely to survive and will have worse outcomes than other stroke patients.

Co-designed with a wide range of stakeholders, including NICE, patient representatives and clinical partners, DWAC provides an easy-to-use toolkit and information materials for patients, clinicians and pharmacists to support shared decision making and to optimise anticoagulation. Further support is also provided in the form of quality improvement and clinical skills training.

Challenge/problem identified

People with atrial fibrillation (AF) are five-times more likely to suffer a stroke than people with a normal heart rhythm, and AF causes one in five of all strokes.Jo-Jerrome-DWAC

People who suffer this type of stroke are less likely to survive and will have worse outcomes than other stroke patients.

Each atrial fibrillation related stroke costs £23,315 on average1.

Despite this:

  • 50% of patients with AF are not receiving appropriate stroke prevention therapy2
  • 230,000 patients are still treated with aspirin despite it no longer being clinically appropriate for AF stroke prevention3
  • 50% of people with AF are not aware of their condition and are at risk of stroke4.

Sources

1National Audit Office (2011)
2NHS Improvement, Innovation in healthcare: turning ideas into reality (2011)
3Stroke Association, State of the nation: stroke statistics (2015)
4NICE Clinical Guidance 36 (2006)

Actions taken

The West of England AHSN developed the Don’t Wait to Anticoagulate project (DWAC) in collaboration with Bayer and Gloucestershire Clinical Commissioning Group (CCG) to help prevent strokes amongst patients with AF by optimising medicines management in primary care.

DWAC offers a range of easy-to-use toolkits for clinicians, pharmacists and patients to aid shared decision making and to optimise anticoagulation for AF patients, supported by quality improvement (QI) and clinical skills training. This includes the website www.dontwaittoanticoagulate.com

In phase one (January to May 2015), the West of England AHSN tested DWAC with 11 GP practices.

In phase two (April 2015 to October 2016), the project was refined and rolled out to a further 51 practices in the Gloucestershire CCG area and was independently evaluated by the University of the West of England.

Phase three of DWAC is ongoing, as the West of England AHSN partners with Bristol CCG to roll out the project to all its GP practices. In addition, a number of AHSNs around the country have expressed an interest in adopting the DWAC project with their healthcare communities.

Impacts/outcomes

DWAC has led to improved patient care, increased confidence in shared decision making, and improved working practices in AF care pathways through a multidisciplinary approach. There has been a strong shift in focus from “Why anticoagulate?” to “Why not anticoagulate?”

During phases one and two of the project, DWAC has potentially prevented up to 21 people from suffering atrial fibrillation related strokes. This represents a projected financial saving of over £489,000.

Don't Wait to Anticoagulate (002)

Partnership working

The West of England AHSN negotiated a ground-breaking Joint Working Agreement with Bayer Healthcare, increasing the capacity of the QI team and adding valuable experience and expertise to the project team.

The project also involved strong partnership working with the Atrial Fibrillation Association, and engaged a wide range of stakeholders in the co-design of patient decision aids, including NICE, Gloucestershire CCG, patient representatives and clinical partners.

Adoption and spread

13 AHSNs are now exploring ways to implement the DWAC project in their own regions. The website www.dontwaittoanticoagulate offers a comprehensive range of resources and how-to guides, and is already being used by teams around the country to roll out the project locally. 

National recognition

The project is receiving widespread national recognition and was well received by the All Party Parliamentary Review Group on AF. The project team took part in the Anticoagulation 2020 Summit. DWAC received a PMEA Award for ‘Excellence in Healthcare Collaboration and Partnerships’ in 2016, and has been recognised as best practice in the Healthcare Pioneers 2017 report, which was developed by the AF Association and endorsed by the All-Party Parliamentary Group on Atrial Fibrillation.

“The information materials and toolkits have been developed to assist both patients and clinicians in their decision-making, ultimately leading to a personalised package of care. It would have been very difficult to have successfully rolled out a project of this sort without the support and expertise of the West of England AHSN.”
Dr Jim Moore, GP, Cheltenham

Which national clinical or policy priorities does this example address?

  • Care and Quality
  • Funding and Efficiency
  • Health and Wellbeing.

Plans for the future

Phase three of DWAC is ongoing, as the West of England AHSN partners with Bristol CCG to roll out the project to all its GP practices. In addition, a number of AHSNs around the country have expressed an interest in adopting the project with their healthcare communities.

The Bristol, North Somerset and South Gloucestershire (BNSSG) Sustainability and Transformation Partnership (STP) is scoping DWAC as part of their stroke prevention pathway, which is likely to form phase four of the local roll out.

Start and end dates

  • Phase one: January to May 2015
  • Phase two: April 2015 to October 2016
  • Phase three: ongoing

Contact us for help and advice

Anna Burhouse, Director of Quality, West of England AHSN
T: 0117 900 2157
E: anna.burhouse@weahsn.net

Vanesther Rees, Communications Manager, West of England AHSN
T: 0117 984 1629
E: vanesther.rees@weahsn.net

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