Health system wide approach to improving and innovating in the management of people with Atrial Fibrillation (AF) through medication optimisation

People who have a stroke caused by Atrial Fibrillation (AF) are often not anti-coagulated effectively. We know that Lancashire (population 1.5 million) has a poor rate of anti-coagulation, with time in therapeutic range often outside NICE guidelines. We have some good practice, but need a system-wide approach to ensure that we achieve results and efficiencies at scale. Our overall goal is to reduce AF related strokes, by optimising medication through introducing innovative combinatorial technologies in the care pathway. Our target population is newly diagnosed AF patients referred for anti-coagulation. We will introduce innovative technologies which will help us offer patients the anti-coagulation approach (genotype-guided dosing) and manage their medication if they are using warfarin (self-monitoring Coaguchek). We will support these systems through a system integrator provided by in-health care, to ensure a joined up approach to informatics. This will save time and clinic visits, and empower patients and ensure successful anti-coagulation. This provides us with efficiencies to manage future demand and complex patients. Our approach to introducing technology will be delivered in three phases. CCGs will continue with the technology after the programme ends if it is effective and cost neutral. The programme will be assessed in terms of numbers of people effectively anti-coagulated as per NICE guidelines (1). We expect that 85% of people are effectively anti-coagulated after 2 years, saving at least 250 strokes (a conservative estimate) in a two year period. This is a potential saving of over £5million (if each stroke costs the NHS £24K per year).