Inspira Health Ltd, Liverpool, UK.
Medicines Optimisation, Bedfordshire Clinical Commissioning Group, Bedford, UK.
Int J Clin Pract. 2020 Apr;74(4):e13465. doi: 10.1111/ijcp.13465. Epub 2020 Jan 13.
Ensuring patients with Atrial fibrillation (AF) are appropriately anticoagulated across NHS Bedfordshire Clinical Commissioning Group (BCCG) with the primary goal of reducing AF-related strokes.
With Inspira Health, BCCG adopted the Primary Care Atrial Fibrillation (PCAF) Service which is led by Consultant Cardiologists. PCAF uses retrospective clinical audit to identify patients who require prospective face-to-face review on the need for anticoagulation.
34 GP practices participated covering a 376 311 population (80% of BCCG). 12 573 patients' medical records were audited. The initial AF register was 7301 patients (AF prevalence 1.9%) and an additional 265 patients were identified through AF casefinder resulting in an AF prevalence of 2.0%. From 7566 patients with AF, 5831 were already on anticoagulants (77.1%), with 50.5% (n = 2947) on VKA medications and 49.5% (n = 2884) on direct oral anticoagulants (DOACs). Of the DOAC patients, 595 (20.6%) required dosage review or up to date blood tests. Case notes were reviewed for 1735 patients not on anticoagulation, with 901 (51.9%) patients deemed not eligible for anticoagulation. This left 834 (48.1%) patients who were eligible for, but not on, anticoagulation. A further 407 (13.8%) patients currently taking VKA medications were deemed sup-optimal with regards to INR control with TTR < 65%. In total 1241 patients were invited for review by a Consultant Cardiologist at their local GP practice, with an attendance rate of 90%. From all face to face and virtual consultations, 908 patients had anticoagulants prescribed, changed, management of INRs improved or were in the process of being anticoagulated at the time of follow-up. From this we would expect 36.3 AF related strokes prevented and a cost saving to the NHS of £470 200 per year.
Through comprehensive audit, BCCG have been able to ensure that patients with AF are appropriately anticoagulated in 80% of their catchment population. This has improved anticoagulation to prevent AF-related stroke.
通过确保国民保健署贝德福德郡临床委托组（BCCG）内的心房颤动（AF）患者得到适当的抗凝治疗，从而降低 AF 相关卒中的发生率。
Inspira Health 使 BCCG 采用了由顾问心脏病专家领导的初级保健心房颤动（PCAF）服务。PCAF 通过回顾性临床审计，确定需要前瞻性面对面审查抗凝治疗需求的患者。
34 家全科医生实践参与，覆盖了 376311 名居民（占 BCCG 的 80%）。对 12573 名患者的病历进行了审核。最初的 AF 登记册有 7301 名患者（AF 患病率为 1.9%），通过 AF 病例发现器发现了另外 265 名患者，AF 患病率为 2.0%。在 7566 名 AF 患者中，已有 5831 名正在服用抗凝剂（77.1%），其中 50.5%（n=2947）服用 VKAs 药物，49.5%（n=2884）服用直接口服抗凝剂（DOACs）。在 DOAC 患者中，有 595 名（20.6%）需要剂量调整或最新的血液检查。对 1735 名未服用抗凝剂的患者进行了病历审查，其中 901 名（51.9%）患者被认为不适合抗凝治疗。这使得 834 名（48.1%）患者有资格但未接受抗凝治疗。另有 407 名（13.8%）正在服用 VKAs 的患者被认为 INR 控制不佳，TTR<65%。共有 1241 名患者应邀在当地全科医生诊所接受顾问心脏病专家的检查，就诊率为 90%。通过所有面对面和虚拟咨询，908 名患者开始服用抗凝剂，改变了抗凝治疗，INR 管理得到改善，或正在接受抗凝治疗。根据随访结果，预计可预防 36.3 例 AF 相关卒中，为国民保健署节省每年 47 万 2000 英镑的费用。
通过全面的审计，BCCG 能够确保在其 80%的服务人群中，AF 患者得到适当的抗凝治疗。这提高了抗凝治疗以预防 AF 相关卒中的效果。
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