This page covers the need and opportunity to reduce the burden of AF-related stroke.
AF-related stroke is a significant burden
People with atrial fibrillation (AF) are 5 times more likely to have a stroke – the fourth largest cause of death in England and Wales.1 An estimated 1.4 million people were living with AF in 2017 in England alone (985,000 diagnosed and 425,000 undiagnosed),2 with the incidence projected to grow significantly.3,4
Under the spotlight as a national priority
AF and stroke are now priority areas for health and care quality improvement. In January 2019, stroke was highlighted as a key area by NHS England in the 'Long Term Plan', an ambitious
10-year plan to improve treatment and care.5 NICE has, alongside their Clinical Guideline [CG180] on the management of AF,6 developed Quality Standard [QS93] to describe high-quality care in priority areas of AF management. This is expected to contribute to much needed improvements in outcomes for adults with AF including mortality and stroke rates, hospital admissions rates, and quality of life.7 Furthermore, a series of AF-specific NICE indicators are available. These enable both HCPs and service providers to monitor and improve the quality of care they deliver, ultimately improving patient outcomes.8
Although clear guidance exists on the prevention of stroke in patients with AF – including NICE CG180 and primary-care-specific guidance from Healthcare Improvement Scotland9 – implementation is often not ideal, leaving many patients at unnecessary risk of AF-related stroke.10 The opportunity is huge – in England alone, adherence to AF guidelines could prevent approximately 7,000 strokes and save over 2,000 lives a year.11
Detect, Protect, Perfect
To help reduce the significant burden of AF-related stroke, the framework ‘Detect, Protect, Perfect’ was developed.12 Whilst developed by partners working together across London, the toolkit highlights simple and practical opportunities for improvement in care that are relevant to practices across the UK. The three domains, Detect (i.e. find more patients), Protect (treat more patients) and Perfect (improve treatment) are covered in more detail across the following pages.
Click here to view ELIQUIS (apixaban) prescribing and adverse event reporting information.
AF = Atrial Fibrillation NHS = National Health Service NICE = National Institute for Health and Care Excellence
- Stroke Association. State of the nation, Stroke statistics. February 2018. Available at: https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2018.pdf. Accessed August 2019.
- Public Health England 2017. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/644869/atrial_fibrillation_AF_briefing.pdf. Accessed August 2019.
- Zoni-Berisso M et al. Clin Epidemiol 2014; 2014: 213–220.
- Krijthe BP et al. Eur Heart J 2013; 34: 2746–2751.
- NHS Long Term Plan. Available at: https://www.longtermplan.nhs.uk/. Accessed August 2019.
- NICE CG180. 2014. Available at: https://www.nice.org.uk/guidance/cg180. Accessed August 2019.
- NICE. QS93. 2015. Available at: https://www.nice.org.uk/guidance/qs93/. Accessed August 2019.
- NICE Standards and Indicators. Available at: https://www.nice.org.uk/standards-and-indicators. Accessed August 2019.
- Healthcare Improvement Scotland / Scottish Intercollegiate Guidelines Network (SIGN). Prevention of stroke in patients with Atrial Fibrillation. January 2014.
- ABPI. SAFI: One year on. 2016. Available at: http://www.abpi.org.uk/publications/safi-one-year-on/ Accessed August 2019.
- NICE 2014_Strokes and deaths preventable from ‘silent killer. Available at: https://www.nice.org.uk/news/article/thousands-of-strokes-and-deaths-preventable-from-silent-killer. Accessed August 2019.
- London Clinical Networks. AF Toolkit: Detect, Protect, Perfect. Available at: www.londonscn.nhs.uk/wp-content/uploads/2017/06/detect-protect-perfect-london-af-toolkit-062017.pdf. Accessed August 2019.
Job code: 432UK1900440-01
Date of preparation: September 2019