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Pan-London AF Primary Care Programme Launch Event 6 th June 2016 Data pack NHS Havering CCG
Pan-London AF Primary CareProgramme Launch Event
6th June 2016
Data pack
NHS Havering CCG
A simplified view of the AF Pathway
1. Pre-Diagnosis
Populationscreening
2. Diagnosis
Assessment
3. Therapy
Behaviouralchange
5. Living withAF
Monitoring
Risk stratification
Case finding
Cross correlationwith otherregisteredconditions
Contact & patientinvitation
Electrocardiograms
Echocardiograms INR devices
Rhythm controlDC Cardioversion ,Class 1c (flecainide)or IIIantiarrhythmicdrugs (amiodaroneor sotalol)
Direct oralanticoagulant(DOAC’s)i.e. Rivaroxaban,Dabigatran,Apixaban,Edoxaban
Electrical /chemicalcardioversioni.e. pacemaker
Catheter
Surgicalablation
Patientactivation
Wearable heartmonitor
Telehealth remotemonitoring
INRtesting
Medicationcompliance
Virtual clinics /Secondary caresupport
Engage
Detect Protect Correct Perfect
Left AtrialAppendage(LAA)
4. Treatment
Drugs /technology
(Detect)
“Don’t waitAnti-coagulate”i.e Warfarin
Pulse checks
Rate control (betablockers(Atenolol,bisoprolol)or rate limiting CCB(Diltiazem,verapamil)
3
Source: Stroke association: https://www.stroke.org.uk/professionals/af-page/af-page-%E2%80%93-ccgs-d
4Source: NCVIN 13-14 and QOF 14-15
Prevalence data for practices in the CCG
5
Anticoagulation rates for practices in the CCG
6
Source: QOF 14-15AF 004 no exceptions
7
Source: QOF 14-15AF 004 no exceptionsQOF Actual
Anticoagulation rates for practices in the CCG
Anticoagulation rates – untreated patients
8
0
10
20
30
40
50
60
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10
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Havering CCG: Anticoagulation rates in patients at high risk of stroke (CHADS2 >1) - QOF 2014/15
Total number untreated pts QOF reported (%) QOF actual (- exceptions) %
-2000
-1500
-1000
-500
0
500
1000
1500
2000
2500
(£15,000,000)
(£10,000,000)
(£5,000,000)
£0
£5,000,000
£10,000,000
£15,000,000
£20,000,000
Yr1 Yr2 Yr3 Yr4 Yr5
5 year change in NHS and LA spend and strokes prevented
Total costs Total savings Budget impact (savings - cost) Strokes prevented
• Based on the NICE AF costing tool (2014) with thesame modelling assumptions
• 84.21% of AF population have CHADSVASC≥ 2
• Baseline demographic data from QOF 2014/15• Current and future treatment estimates from NICE
AF costing report 2014• 3 NOACS (not edoxaban) used in equal proportion• Cost of stroke £12,228 (NICE); major bleed cost
£1,173 (NICE)• Cost of long-term nursing care £6,880 does not
include all social care costs• Drug costs from MIMS 2015• Does not include other economic benefits• Does not include increase in AF incidence year-on-
year• Does not include additional patients
identified through screening
Modelling assumptions
Health and budget impact modelling – London
Stroke
sP
reven
ted
Savi
ngs
Co
sts
Benefits
• Prevent over 2000 strokes over 5 years• ~ 400 - 500 lives saved over 5 years• Net savings seen at year 3, and accumulative
net savings to health economy of ~ £3.5 millionover 5 years.
• Based on the NICE AF costing tool (2014) with thesame modelling assumptions
• 84.21% of AF population have CHADSVASC≥ 2
• Baseline demographic data from QOF 2014/15• Current and future treatment estimates from NICE
AF costing report 2014• 3 NOACS (not edoxaban) used in equal proportion• Cost of stroke £12,228 (NICE); major bleed cost
£1,173 (NICE)• Cost of long-term nursing care £6,880 does not
include all social care costs• Drug costs from MIMS 2015• Does not include other economic benefits• Does not include increase in AF incidence year-on-
year• Does not include additional patients
identified through screening
Modelling assumptions
Health and budget impact modelling – CCG
Stroke
sP
reven
ted
Savi
ngs
Co
sts
Key contacts for the programme are either through your local Academic Health Science Network or the London Strategic Clinical Network:
[email protected] (Health Innovation Network AHSN, South London)
[email protected] (Imperial AHSN, North West London)
[email protected] (UCLPartners AHSN, North East and North Central London)
[email protected] (Strategic Clinical Network)
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