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Dr Matthew Fay (GPwSI Cardiology, Westcliffe Medical Practice) and John Campbell (NPwSI in Cardiology, Woodbridge Medical Practice) share their recommendations on effective GP/multidisciplinary team (MDT) communication to prioritise the diagnosis of AF and management of AF-related stroke risk. This article is sponsored by the Bristol-Myers Squibb (BMS)/Pfizer Alliance.
Dr Matthew Fay (MF) and John Campbell (JC) are members of the NICE CG180 Guideline Development Group, with experience of diagnosing AF and managing the risk of AF-related stroke. Here they offer some tips on how best to engage MDT members with patients, and in doing so support the timely diagnosis of AF and reduction of AF-related stroke risk, through the implementation of the NICE CG180 Guidelines and by adhering to the Quality and Outcomes Framework (QOF).
AF advocates in your practice
JC: “Through my years of clinical experience, it’s helpful electing a cardiovascular/AF advocate in your practice to communicate the need for AF to be high on the care agenda. These experts can empower MDT members who regularly see patients for other health issues to check for AF during consultations (where appropriate).”
Overcome knowledge barriers
MF: “Patients may not have prior knowledge of AF and/or the condition’s potential risks when presenting with AF symptoms (e.g. breathlessness or chest discomfort).1 Therefore, initial discussions about possible AF diagnosis can be a shock to patients. GPs/MDTs must find a way to discuss AF and its potential risks so that all parties are comfortable.
When AF is diagnosed and anticoagulation is considered, provide patients with all of the information required to make an informed decision. Whilst patient choice should be respected, ensure patients understand that they can return to discuss their options, should they change their mind.”
Ensure timely diagnosis
JC: “When AF is suspected in a patient the clock is ticking to proceed with next steps, which effective communication between all involved can help with. When referring AF-suspected patients for ECGs, remember that ECG quality varies1,2,3 and multiple ECGs may be needed to diagnose/rule out AF. Where suitable, handheld digital heart rhythm monitors may help streamline this process.”
MF: “The time taken to have discussions around possible anticoagulation therapy will vary for every patient, e.g. the urgency for an older patient who has had an AF-related stroke will be greater than an otherwise healthy 50-year-old recently diagnosed with AF. AF patients have a greater risk of stroke than people without the condition4 and in my opinion, all AF patients should be considered for anticoagulation therapy. Using the CHA₂DS₂VASc score will identify those truly at low risk (score of less than 1) who probably should not receive an anticoagulant due to an increased risk of bleeding events outweighing the low risk of stroke”.
Make the most of an engaged team
MF: “GP/MDT discussions around anticoagulation therapy for AF-diagnosed patients can be beneficial, encouraging informed conversations around the most appropriate option (if any) for individual patients. Consider bringing the patient and their family/carer into discussions at this point, so all parties are aware of evaluated options.
GPs/MDTs should consult secondary care colleagues regarding AF patient care when needed, such as if an anticoagulated AF patient has their therapy stopped in hospital following an acute medical episode. In this scenario, the GP/MDT and secondary care team should discuss possibly restarting the patient’s anticoagulation if bleeding risk is stabilised.”