Improving anticoagulation in atrial fibrillation: observational study in three primary care trusts.
BACKGROUND
Atrial fibrillation (AF) is a cause of stroke, and undertreatment with anticoagulants is a persistent issue despite their effectiveness.


AIM
To increase the proportion of people with AF treated appropriately using anticoagulants, and reduce inappropriate antiplatelet therapy.


DESIGN OF STUDY
Cross-sectional analysis.


SETTING
Electronic patient health records on 4604 patients with AF obtained from general practices in three inner London primary care trusts between April 2011 and 2013.


METHOD
The Anticoagulant Programme East London (APEL) sought to achieve its aims through an intervention with three components: altering professional beliefs using new clinical guidance and related education; facilitating change using computer software to support clinical decisions and patient review optimising anticoagulation; motivating change through evaluative feedback showing individual practice performance relative to peers.


RESULTS
From April 2011 to April 2013, the proportion of people with CHA2DS2-VASc ≥1 on anticoagulants increased from 52.6% to 59.8% (trend difference P<0.001). The proportion of people with CHA2DS2-VASc ≥1 on aspirin declined from 37.7% to 30.3% (trend difference P<0.001). Comparing the 2 years before the intervention with the 2 years after, numbers of new people on the AF register almost doubled from 108 to 204.


CONCLUSIONS
The APEL programme supports improvement in clinical managing AF by a combined programme of education around agreed guidance, computer aids to facilitate decision-making and patient review and feedback of locally identifiable results. If replicated nationally over 3 years, such a programme could result in approximately 1600 fewer strokes every year.
['Robson|John|J|', 'Dostal|Isabel|I|', 'Mathur|Rohini|R|', 'Sohanpal|Ratna|R|', 'Hull|Sally|S|', 'Antoniou|Sotiris|S|', 'Maccallum|Peter|P|', 'Schilling|Richard|R|', 'Ayerbe|Luis|L|', 'Boomla|Kambiz|K|']
D017677:Age Distribution D000368:Aged D000369:Aged, 80 and over D000925:Anticoagulants D001281:Atrial Fibrillation D003430:Cross-Sectional Studies D011307:Drug Prescriptions D004363:Drug Utilization D004562:Electrocardiography D005260:Female D006801:Humans D016015:Logistic Models D008131:London D008297:Male D008875:Middle Aged D010975:Platelet Aggregation Inhibitors D015995:Prevalence D011320:Primary Health Care D015397:Program Evaluation D058996:Quality Improvement D018570:Risk Assessment D012720:Severity of Illness Index D017678:Sex Distribution D020521:Stroke D016896:Treatment Outcome D014505:Urban Population
anticoagulants atrial fibrillation stroke clinical decision support systems patterns prescribing primary health care