“The work reviewing our performance in Atrial Fibrillation (AF), and helping defining the service to improve the outcomes in patients with AF, has been of great value. We were able to provide very successful educational events for GPs.  Further events focused on our first AF related Local Incentive Scheme are planned, all through the help received from ICHP.”
Dr Ajit Shah, Clinical Director, NHS Brent Clinical Commissioning Group

OverviewKSS Hydrate

The programme reduces the risk of unidentified Atrial Fibrillation (AF) in North West London through the identification and treatment of 2,000 patients who are at high risk of a stroke.

To reduce the risk associated with Atrial Fibrillation we set the challenge to:

  • Bring GPs and other healthcare professionals together to identify patients at risk of AF-related strokes;
  • Get AF patients the right medication at the right time;
  • Give staff the right skills and tools to support AF prevention.

These innovations help transform outcomes for patients and drive efficiency in the NHS.

The activity used training sessions at Wembley stadium and new technology to bring professionals together,  demonstrating best practice and showing that that through

  • Collaboration;
  • Experimentation; and
  • Innovation;

we will ensure patients are on the right treatment and truly reduce the risk of AF in North West London.

This has a direct impact on patient health and wellbeing, as well as the identification of substantial efficiency savings for the NHS of around £24,000 per patient through avoiding AF-related strokes. The positive impacts will continue to grow as the programme is further extended across the region.

Challenge/problem identified

Atrial Fibrillation (AF) is an irregular heartbeat and is the most common form of cardiac arrhythmia affecting approximately 900,000 people in England, (1.74% of the population). National data suggests that AF accounts for approximately 20% of all strokes.[1]

In North West London, Public Health England estimates there are more than 17,000 people with undiagnosed AF. This results in a considerably higher risk of AF related strokes for those not undergoing treatment.

We also know that over 4,300 patients with identified AF in North West London and at a high risk of stroke are not on the anticoagulation treatment recommended by NICE guidelines.[2]

Actions taken

NICE Clinical Guideline [CG180] identifies a number of treatments and interventions to address the challenges of AF prevention.

The project team started by developing a strong partnership with patients, innovators and entrepreneurs, industry, academics, charities and the local NHS.

We co-designed and developed a range of approaches and bespoke training packages to target specific healthcare professionals. This included:

  • A series of pop-up innovation workshops: Bringing together stakeholders from across the AF pathway in North West London including clinicians, industry partners and patients. The aim of the sessions was to identify and share best practice – both technology-based and process innovations. We divided the AF pathway into stages from early detection through to diagnosis; selecting the right anticoagulant and living with the condition. Delegates were encouraged to ‘think local’, planning what and how AF care could be improved in their area. Underpinning all these themes was how innovation is key to bringing high levels of quality to AF treatment in NW London.
  • Pathway Redesign: ICHP collaborated with a number of Clinical Commissioning Groups (CCGs), looking at the barriers to excellent care for AF patients. We worked alongside cardiovascular leads; reducing variation and increasing levels of anticoagulation.
  • ‘Drills and Skills’ AF sessions for GPs: Developed in collaboration with leading primary and secondary care experts and delivered across NW London and hosted in Wembley stadium. The sessions were well attended with excellent feedback. Neighbouring CCGs accessed the core materials to adapt locally, ensuring the learning could be quickly and effectively shared more widely.
  • Online conferences: We piloted the use of WebEx’s (online conference) tools to increase engagement.
  • Online community: We supported the development of a peer engagement network for AF, a secure extranet community developing peer-to-peer dialogue.
  • Pan-London toolkit: ICHP worked in collaboration with neighbouring London AHSNs (Health Innovation Network and UCLPartners) along with the London Clinical Networks to develop a toolkit identifying and sharing best practice from across the AHSN network

All of these activities are delivered with regular and ongoing dialogue with key stakeholders, both face to face and digitally.

Impacts/outcomes

“The model for calculating the benefits and costing the project (derived from the NICE Commissioning tool) is particularly useful. The team is instrumental in finding user friendly audit software for the audits. They assisted in seeking grants for the project and we were awarded £55k in total.”
Caroline Davidson, Commissioning Manager Long Term Conditions, NHS Hillingdon CCG

2,000 additional patients in North West London have been identified and treated.

The programme has improved patient health and wellbeing, reduced risk and achieved substantial efficiency savings through avoiding AF-related strokes.

There are five key outcomes from the programme so far:

1. Improved understanding amongst healthcare professionals and patients of best practice anti-coagulation services, delivery and measurement
Service redesign, incentivisation and partnership working has had a measurable and sustainable positive impact on AF prevention if North West London.

2. Prevented an estimated 250 strokes and 60 stroke-related deaths every year
Greatly improved AF detection rates and anti-coagulation levels.

3. Acceleration of the adoption and spread of innovation
True collaboration with industry, SMEs, ABPI and SBRI ensured we were able to break down cultural and structural barriers to accelerate the adoption of innovation and improvement.

4. Successful diffusion of evidence-based anti-coagulation services
Collaboration with partners allowed us to deliver a series of bespoke and effective training packages.

5. Generation of significant annual efficiency savings amounting to around £24,000 per patient
Savings were identified through developing better care pathways, more effective treatment and prevention.

Partners include:

  • Yassir Javaid (GP and Cardiovascular Lead at NENE CCG)
  • Ravi Assomull (Consultant Cardiologist at London North West Healthcare NHS Trust).
  • We were also joined by a local cardiology expert, Joseph Tomson (Consultant Cardiologist at Royal Free Hospital), who provided an insight into Brent community cardiology service.

Plans for the future

Phase two delivery of Preventing Atrial Fibrillation in North West London promises the following:

  • Further engagement: More skills and drills masterclasses across CCGs in NW London. These will be followed up with ‘Pathway Optimisation’ meetings with the CCG leadership resulting in improved care delivery for AF patients
  • Identification of new cases: Selected GP practices will be involved with a series of ‘Case Finding’ pilots
  • AF stadium days: Screening Initiatives to raise public awareness During Awareness Weeks at local sport stadia (for example Heart Rhythm Week/AF Awareness week)
  • Better data: working with health economists and analysts to improve data capture and sharing for partners, with better progress tracking and improvement

Masterclass Feedback:

  • “I attended your sessions in February 2017. A fantastic meeting! I thoroughly enjoyed it and I found it very useful”
  • “I attended fantastic training about AF and anticoagulation yesterday at Wembley stadium”
  • “What a useful day! Extremely informative with really engaged and enthusiastic delivery by passionate and knowledgeable presenters.”

Start and end date

April 2016 – March 2018

Contact us for help and advice

Anthony Anandan, ICHP Innovation Delivery Lead
E: Anthony.anandan@imperialcollegehealthpartners.com

Amy Darlington, ICHP Director of Communication & Engagement
E: Amy.darlington@imperialcollegehealthpartners.com

Find out more

Atrial Fibrillation Workshops – Imperial College Health Partners from Imperial College Health Partners on Vimeo.