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NICE has yesterday published a new quality standard which sets out priorities for healthcare professionals on the treatment and management of atrial fibrillation (AF) in adults.

AF is the most common heart rhythm disorder and is thought to affect around 900,000 people in England. It occurs when the electrical impulses controlling the heart rhythm become disorganised, so that the heart beats irregularly and, occasionally, too fast and so cannot pump blood around the body efficiently.

AF leads to deterioration in the function of the atria (the upper chambers of the heart which receive blood returning to it from other areas of the body) and prevents complete expulsion of blood from the heart.

People with AF have a higher risk of having a stroke because the blood can become stagnant and form blood clots. Anticoagulation therapy can help to prevent strokes by reducing the likelihood of a blood clot forming.

The quality standard includes 6 statements aimed at healthcare professionals caring for people in danger of developing, or who already have, AF. These include:

• Adults with a type of AF called ‘non-valvular’ who have a stroke risk score of 2 or more (as estimated by their doctor using the CHA2DS2-VASC risk score) are offered treatment with an anticoagulant to lower their risk of having a blood clot that could cause a stroke.
• Adults with atrial fibrillation who are prescribed an anticoagulant talk with their doctor at least once a year about the types of anticoagulants they could have and the advantages and disadvantages of each.
• Adults with atrial fibrillation who are taking a type of anticoagulant called a vitamin K antagonist (such as warfarin) have regular blood tests to check whether the dose they are taking is at the right level to reduce their risk of stroke and bleeding problems.
• Adults with atrial fibrillation who still have symptoms after treatment are referred within 4 weeks for specialised care that aims to ease their symptoms and reduce their risk of having a stroke or heart attack.

The quality standard also includes NICE’s first developmental statementi on the provision and use of monitors (coagulometers) for people on long-term vitamin K antagonist therapy (such as warfarin) so they can check how well the treatment is working.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Atrial fibrillation can be a distressing condition and people with it have an increased risk of having a stroke. Therefore it’s important that people with AF have their condition managed effectively in order to eliminate the significant risk of stroke and prevent deterioration in their quality of life. This quality standard, by prioritising areas for improvement across the AF care pathway, will help to ensure that fewer people die unnecessarily as a result of poor treatment.”

Dr Matthew Fay, a GP and specialist member of the committee that developed the standard, said: “This quality standard brings in to sharp focus the key issue of stroke prevention. In doing so it continues to highlight the need for a change in practice so that everyone with AF is considered for anticoagulation and the quality of that anticoagulation is always kept under review by clinicians and commissioning groups.

“The ineffectiveness of aspirin and the need to remove it from the AF patient pathway receives a much needed, and rare, negative statement. This should provide the impetus to those who still speculate on the value of aspirin from historic practice to have the discussion with their patients about the benefits of anticoagulation hopefully before, and not after a devastating stroke event.”

Prof Beverley Hunt, Medical Director of Thrombosis UK and specialist member of the committee that developed the standard, said: “The NICE AF quality standard provides a minimum standard of care expected within NHS England. It demands that patients at high risk of stroke without a bleeding risk are offered blood thinners - either warfarin or the newer oral anticoagulants - but not aspirin. Every patient needs to decide with their health care professional which is most suitable for them and they should be reviewed annually. Those who self-monitor their warfarin with a home coagulometer should be supported. Lastly if treatment fails to control symptoms, then patients should be referred for specialist management within 4 weeks.

“These Quality Standards are important because without adequate blood thinners many patients would have a preventable stroke, and stroke can have a devastating impact on lives causing loss of movement, independent living and even death.”

The full standard is available online at http://www.nice.org.uk/guidance/qs93

For more information, please call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813, or email pressoffice@nice.org.uk.

Notes to Editors

References

      i.  Developmental quality statements set out an emergent area of cutting-edge service delivery or technology currently found in a minority of providers and indicating outstanding performance. They will need specific, significant changes to be put in place, such as redesign of services or new equipment.

     ii.  Costs and Benefits of Antithrombotic Therapy in Atrial Fibrillation in England: An Economic Analysis based on GRASP-AFhttp://www.nhsiq.nhs.uk/media/2566025/af_economic_analysis_final.pdf

About the quality standard

1. The quality standard for atrial fibrillation is available on the NICE website athttp://www.nice.org.uk/guidance/qs93
2. The quality standard is different to the institute’s atrial fibrillation clinical guideline which was published last year and gives recommendations across broad areas of care to help identify and manage atrial fibrillation.

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.