CVD prevention: detecting atrial fibrillation and anticoagulation

How NICE resources can support local priorities

Making the case for action

Atrial fibrillation (AF) increases the risk of stroke, heart attack and dementia, so is a priority for many local partnerships. Recent analysis from Public Health England and NHS England shows that, over 3 years, achieving optimal treatment for people diagnosed with AF could prevent up to 14,220 strokes across England. This could save £240 million. They've used published data to produce infographics for each local area.

The NHS Long Term Plan includes an ambition to prevent 150,000 strokes, heart attacks and dementia cases over the 10 years to 2029 by improving the detection and management of AF, hypertension and high cholesterol. To support this, the National CVD Prevention System Leadership Forum has agreed specific ambitions for detecting and managing these high-risk conditions, known as ‘the ABC’:

  • atrial fibrillation
  • blood pressure
  • cholesterol.

The ambitions for AF are:

  • 85% of the expected number of people with AF are detected by 2029
  • 90% of people with AF who are at high risk of a stroke have adequate anticoagulation by 2029.

We've published guidance and quality standards on AF, and tools to help with putting it into practice. Our guidance is aligned with the NHS England RightCare and Public Health England cardiovascular disease (CVD) prevention pathway and will support delivery of the national ambitions for AF.

Focusing on AF will support the Five Year Forward View priority ‘Getting serious about prevention’. 

Use data about your area

Getting data on what’s happening in your area helps you compare how you're doing with other areas, and make decisions on how to improve care. These resources from Public Health England and RightCare include data on cardiovascular disease, including atrial fibrillation:

  • Atrial fibrillation reports include practical tips for GP practices and clinical commissioning groups (CCGs) on how they can get better at preventing and treating strokes.
  • CVD primary care intelligence packs look at prevention, diagnosis, care and outcomes. They also allow for comparison between CCGs and GP practices.
  • CVD disease profiles for each CCG look at coronary heart disease, diabetes, kidney disease and stroke.
  • RightCare ‘where to look’ packs include headline opportunities, improvement opportunity tables and pathways on a page. The page shows how CCGs in each local area differ from their peers.

Dr Matt Kearney, National Clinical Director for CVD Prevention, explains how we can help you tackle CVD in your area.

An illustration showing a magnifying glass over a heartbeat reading.

Finding the right information

NICE guidance to help you improve detection and anticoagulation

The easiest way of finding all our guidance on AF is to go to our topic page on heart rhythm conditions. Guidance is listed by type.

Our guideline atrial fibrillation: management has recommendations on everything from diagnosis and risk assessment to anticoagulation.  

Our quality standard on atrial fibrillation includes 6 quality statements that will help with identifying areas for improvement. See how to use quality standards for more information.

Our NICE Pathway on atrial fibrillation is a set of interactive flowcharts that show how everything we've published fits together. The following video explains how to use NICE Pathways.

Other key AF guidance

Diagnostics guidance

Atrial fibrillation and heart valve disease: self‑monitoring coagulation status using point‑of‑care coagulometers (the CoaguChek XS system and the INRatio2 PT/INR monitor).

Medtech innovation briefing

AliveCor Heart Monitor and AliveECG app (Kardia Mobile) for detecting atrial fibrillation.

Medical technologies guidance

WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension.

Illustration of a signpost pointing in two different directions.

Support for improving quality

Illustration showing three cogs that fit together.

We publish a range of tools to help you use our guidance and quality standards to improve quality.

You can find these on the tools and resources tab for each piece of guidance or standard. Tools for atrial fibrillation include:

  • a patient decision aid and user guide to support shared decision-making with patients
  • a baseline assessment tool for services to check if practice is in line with our guideline
  • a costing report and template to calculate the local costs of implementing the guideline
  • a list of shared learning case studies.

There's a full list of shared learning case studies on the heart rhythm conditions topic page, and we've summarised highlights from 2 of them below.

For a summary of the evidence base to support medicines optimisation, see our key therapeutic topic advice on anticoagulants, including non-vitamin K antagonist oral anticoagulants (NOACs).

Our impact report on CVD prevention highlights the progress made by the healthcare system by implementing our guidance.

NICE indicators

We’ve developed a set of outcome indicators for AF. Visit our standards and indicators page and select atrial fibrillation from the ‘filter by subject’ dropdown menu.

Indicators can be particularly useful when:

  • creating local performance dashboards
  • benchmarking performance against national data
  • developing local quality improvement schemes
  • measuring progress that local health systems are making on outcomes.

Shared learning case studies

Audit tool helps identify and improve treatment for AF patients at high risk of stroke

A West Hampshire project led to a 10% reduction in the number of strokes expected annually among people with AF. It also led to significant cost savings. From April to July 2015 there were 7 fewer strokes than expected, saving between £11,000 and £44,000. 741 more people received anticoagulant medicine.

It was the result of a partnership between West Hampshire CCG and Boehringer Ingelheim working with 51 GP practices and data audit company PRIMIS. Practice staff were trained to use the GRASP-AF audit tool to identify people with AF at high risk of stroke and then offer them anticoagulants.

A group of medical professionals having a discussion in a hospital setting.

Specialist clinics increase use of anticoagulation treatment among people with AF

Specialist clinics in 21 GP practices across Fylde and Wyre more than doubled the number of people with AF who received anticoagulation treatment to prevent a stroke. Initial findings showed that 36 additional patients had been added to the AF registers and 40 new people had received anticoagulation treatment. Overall, the estimated annual number of strokes expected fell from 66 to 54.

The clinics, involving a specialist nurse and a cardiology consultant, reported that most patients hadn't known about the link between AF and their risk of having a stroke. Most (99%) said they found the clinic useful and 93% would recommend it to others.

Female scientist holding a red transparent pill.