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GPs set for stricter targets on warfarin treatment



By Nigel Praities

Exclusive: GPs will be expected to place more patients on warfarin under plans to tighten QOF and NICE guidance on atrial fibrillation, a top Department of Health adviser has revealed.

Heart tsar Professor Roger Boyle said that GPs were placing too many patients with atrial fibrillation on aspirin, and NICE guidance and related QOF indicators should be changed so that more patients were placed on warfarin to prevent stroke.

Professor Boyle told Pulse the Department of Health had already submitted evidence to NICE to prompt a change in the current QOF indicators.

‘GPs tend to use aspirin because it is easier particularly in the elderly, whereas the evidence base shows that warfarin can almost abolish the risk of embolic stroke with atrial fibrillation and the balance of risk is very much in favour of using warfarin even in the elderly.’

‘The notion that they forget to take their tablets, or take the wrong tablets and are falling all over the place and are bleeding just is not true. So the NICE guideline needs to be updated and we also need to update the QOF,’ he said.

The current QOF indicator looks at the percentage of patients with atrial fibrillation who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy, and Professor Boyle suggested that this should be changed to directly incentivise the use of warfarin. The NICE guidance on atrial fibrillation is due to be reviewed next year.

Professor Boyle – speaking at an RCGP debate on cardiovascular disease this week – admitted there would need to be better anticoagulant monitoring systems to support the change, but said it could prevent around 10,000 strokes a year.

Professor David Fitzmaurice, professor of primary care at the University of Birmingham and a GP in the city, agreed with Professor Boyle.

‘The wording needs to reflect that the majority of patients with atrial fibrillation should be taking warfarin, not aspirin,’ he said. ‘This will probably have to take into account CHADS score.’

GPs are set for stricter targets on warfarin treatment RCGP debate on CVD