Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013

High Weald Lewes Havens CCG

South East Coast SCN -Atrial Fibrillation Project

• Earlier detection and anticoagulation optimisation of patients with atrial fibrillation

• First step will be agreement on recommendation of NICE anticoagulation guidelines as best practice. New NICE Guidance will be published on the 11th June 2014

• Task to Finish Group being established to implement the NICE guidance• Will be followed by the development of a best practice model for earlier

detection and management • SSNAP Data – July to September 2013 most up to date• QOF Data from 2012/13 most up to date• Uses CHADS2 scoring. This will be replaced by CHADSVASC in NICE

Guidance

SSNAP Data – July to September 2013

• Nationally 19.8% of Stroke patients had previous AF. SEC is 20.5 %.Range in SEC is 12.7 to 35.5%

• Best practice is anticoagulant prescribing for AF• Nationally 24.5% of Stroke patients with AF were not

previously prescribed anticoagulants or anti-platelets. SEC is 26.8%. Range is 7.7 % to 40%

• Nationally 32.5 % of Stroke patients with AF were previously prescribed anticoagulants only. SEC is 31.4%. Range is 0 – 70%

SSNAP Data – July to September 2013

National

St Pete

r's Hospita

l

Princes

s Roya

l Hospita

l Hay

wards H

eath

Royal Su

ssex C

ounty Hospita

l

Darent V

alley

Hospita

l

Kent a

nd Canter

bury Hosp

ital

Queen El

izabeth

the Q

ueen M

other Hosp

ital

William

Harvey

Hospita

l

Conquest Hosp

ital

Eastbourne D

istrict

Genera

l Hosp

ital

Epsom Hospita

l

Frimley

Park Hosp

ital

Maidsto

ne Distr

ict Gen

eral H

ospital

Tunbrid

ge Well

s Hosp

ital

Medway

Mari

time Hosp

ital

Royal Su

rrey C

ounty Hospita

l

East S

urrey H

ospital

St Rich

ards H

ospital

Worthing H

ospita

l05

10152025303540

Admitted Stroke Patients with Previous AFSSNAP - July to September 2013

AF Strokes = 306

%

National

St Pete

r's Hospita

l

Princes

s Roya

l Hosp

ital H

ayward

s Hea

th

Royal Su

ssex C

ounty Hospita

l

Darent V

alley

Hospita

l

Kent a

nd Canter

bury Hosp

ital

Queen El

izabeth

the Q

ueen M

other Hosp

ital

William

Harvey

Hospita

l

Conquest Hosp

ital

Eastbourne D

istrict

Genera

l Hosp

ital

Epsom Hospita

l

Frimley

Park Hosp

ital

Maidsto

ne Distr

ict Gen

eral H

ospital

Tunbrid

ge W

ells Hosp

ital

Medway

Mari

time Hosp

ital

Royal Su

rrey C

ounty Hospita

l

East S

urrey H

ospital

St Rich

ards H

ospital

Worthing H

ospita

l0

5

10

15

20

25

30

35

40

45

Stroke Patients with Previous AF on no anticoagulant or anti-platelet medication

SSNAP - July - September 2013AF Strokes = 306

%

National

St Peter's Hospital

Princess Royal Hospital Haywards Heath

Royal Sussex County Hospital

Darent Valley Hospital

Kent and Canterbury Hospital

Queen Elizabeth the Queen Mother Hospital

William Harvey Hospital

Conquest Hospital

Eastbourne District General Hospital

Epsom Hospital

Frimley Park Hospital

Maidstone District General Hospital

Tunbridge Wells Hospital

Medway Maritime Hospital

Royal Surrey County Hospital

East Surrey Hospital

St Richards Hospital

Worthing Hospital

0 10 20 30 40 50 60 70 80

Stroke Patients with Previous AF- Prescribing prior to admissionSSNAP July to September 2013

AF Strokes = 306

Anti-platelet onlyAnticoagulant OnlyBoth

%

QOF Atrial Fibrillation Indicators – 2012/13 by CCG

• Four Indicators– Prevalence (percentage on QOF AF Register/practice population)– AF05 – Percentage on AF register who have had a CHADS2 score in the previous 15

months (except those whose previous score was greater than 1)– AF06 – In those with a CHADS2 score higher than 1 in last 15 months– those who are on

anti-coagulants or anti-platelets (minus exceptions)– AF07 – In those with a CHADS2 score higher than 1 in last 15 months – those who are on

anti-coagulants (minus exceptions)

• Any correlation between QOF CCG indicator results and AF stroke admissions and prescribing? E.g. High stroke admissions with AF in local hospitals and low anticoagulant prescribing for those admissions and low prevalence and low anticoagulant prescribing (for the known AF’s) in CCG data

AF Prevalence by CCG in Sussex

Brighton & Hove Coastal West Sussex Crawley Eastbourne, Hailsham &

Seaford

Hastings & Rother High Weald Lewes Havens

Horsham & Mid Sussex

SUSSEX

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

Practice KSS England

SUSSEX

Percentage of people on practice list on atrial fibrillation register

Source: QOF 2012/13

AF05 by CCG in Sussex

Brighton & Hove Coastal West Sussex Crawley Eastbourne, Hailsham &

Seaford

Hastings & Rother High Weald Lewes Havens

Horsham & Mid Sussex

SUSSEX

95.0%

95.5%

96.0%

96.5%

97.0%

97.5%

98.0%

Practice KSS England

SUSSEXAF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)

Source: QOF 2012/13

AF06 by CCG in Sussex

Brighton & Hove Coastal West Sussex Crawley Eastbourne, Hailsham &

Seaford

Hastings & Rother High Weald Lewes Havens

Horsham & Mid Sussex

SUSSEX

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

Practice KSS England

SUSSEXAF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15 months), the percentage of patients who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy.

Source: QOF 2012/13

AF07 by CCG in Sussex

Brighton & Hove Coastal West Sussex Crawley Eastbourne, Hailsham &

Seaford

Hastings & Rother High Weald Lewes Havens

Horsham & Mid Sussex

SUSSEX

74.0%

76.0%

78.0%

80.0%

82.0%

84.0%

86.0%

SUSSEXAF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation drug therapy

Source: QOF 2012/13

QOF Atrial Fibrillation Indicators – 2012/13 by Practice

• What to look for– Does the prevalence look low for this practice population and demographics? All other

indicators are based on this. Low numbers may mean that some AF patients have not been diagnosed

– AF05 – Low rates will indicate that the practice isn’t routinely assessing those on the AF Register for CHADS2 and changes to their risk

– AF06 – Best practice is for those with identified AF to be on anticoagulant therapy not anti-platelet therapy. Compare rates with AFO7. High rates on AF06 but lower rates on AF07 indicates a high usage of anti-platelet therapy .

– AF07 - Best practice is for those with identified AF to be on anticoagulant therapy . Compare with prevalence and AF05 - high rates but low prevalence and low routine assessment may indicate that only small numbers are being managed well

GP Practice Codes in High Weald Lewes and Havens CCG

G81024 ASHDOWN FOREST HEALTH CENTREG81030 BELMONT SURGERYG81086 BIRD IN EYE SURGERYG81692 CENTRAL SURGERYG81061 CHAPEL STREET SURGERYG81627 FOXHILL MEDICAL CENTREG81614 GROOMBRIDGE & HARTFIELD MEDICAL GROUPG81088 HEATHFIELD SURGERYG81097 MANOR OAK SURGERYG81100 MERIDIAN SURGERYG81007 MID DOWNS MEDICAL PRACTICEG81016 QUAYSIDE MEDICAL PRACTICEG81035 RIVER LODGE SURGERYG81043 ROTHERFIELD SURGERYG81053 ROWE AVENUE SURGERYG81055 SAXONBURY HOUSE PRACTICEG81021 SCHOOL HILL MEDICAL PRACTICEG81045 ST ANDREWS SURGERYG81019 THE BEACON SURGERYG81102 THE BUXTED SURGERYG81037 THE MEADS SURGERYG81040 WOODHILL SURGERY

Prevalence by Practice compared to KSS (Red line) and England (Green Line)

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

Practice KSS

NHS HIGH WEALD LEWES HAVENS CCG

Percentage of people on practice list on atrial fibrillation register

Source: QOF 2012/13

AFO5 by Practice compared to KSS (Red line) and England (Green Line)

0%

20%

40%

60%

80%

100%

120%

Practice KSS

NHS HIGH WEALD LEWES HAVENS CCGAF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)

Source: QOF 2012/13

AFO6 by Practice compared to KSS (Red line) and England (Green Line)

0%

20%

40%

60%

80%

100%

120%

Practice KSS

NHS HIGH WEALD LEWES HAVENS CCGAF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15 months), the percentage of patients who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy.

Source: QOF 2012/13

AFO7 by Practice compared to KSS (Red line) and England (Green Line)

0%

20%

40%

60%

80%

100%

120%

Practice KSS

NHS HIGH WEALD LEWES HAVENS CCGAF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation drug therapy

Source: QOF 2012/13