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QOF will overlook ‘significant proportion’ of over 65s with atrial fibrillation, say experts

QOF indicators for anticoagulation therapy will overlook a ‘significant proportion' of older people with atrial fibrillation unless pulse checks are routinely carried out by practices, say experts.

The call for routine screening in all patients aged 65 or over comes as Department of Health screening advisers look again at the evidence for a national screening programme.

The QOF for 2012/13 contains new indicators that measure practices on the proportion of patients that are put onto anticoagulation therapy after being given a CHADS2 score of greater than one.

Writing in this month's edition of the British Journal of General Practice, Professor John Campbell,  professor of general practice, and Dr Martin James, consultant stroke physician, at the Peninsula College
of Medicine and Dentistry in Exeter, said this was the wrong approach as an age over 65 years already conferred ‘substantial risk'.

Professor Campbell said: ‘The use of the CHADS2 score in the QOF indicators risks overlooking a significant proportion of older people at appreciable thromboembolic risk who would benefit from

He urged routine screening by GPs instead: ‘Radial pulse checking at every primary care consultation with a person over 65 years, with a 12-lead ECG for individuals with any irregularity, is relatively
cheap, costing approximately £337 for every case detected, and with a high probability that screening and anticoagulation are cost-effective through substantial reductions in disabling stroke.'

A consensus panel held by the Royal College of Physicians in Edinburgh in March concluded that a screening programme for atrial fibrillation satisfied the criteria set by the National Screening Committee for a national programme.

The NSC is currently looking at the evidence for atrial fibrillation screening and will report back to ministers in November this year.

It also comes after a recent UK study showed that 8% of patients in primary care aged over 75 years had atrial fibrillation, and that mortality risk was 57% higher in this group.

Study leader Professor Richard Hobbs, head of the Department of Primary Care Health Sciences at the University of Birmingham and a GP in the city, said the study showed that anyone aged over 75 years
should be on some sort of anticoagulation therapy.

He said: ‘If you use one of the scores such as CHADS2 it will underweight those aged over 75 years.'
'You don't need a risk score, they are at sufficiently high risk to warrant treatment.'