Quality standard

Quality statement 1: Anticoagulation to reduce stroke risk

Quality statement 1: Anticoagulation to reduce stroke risk

Quality statement

Adults with non‑valvular atrial fibrillation and a CHA2DS2-VASC stroke risk score of 2 or above are offered anticoagulation.

Rationale

Adults with non‑valvular atrial fibrillation and a CHA2DS2‑VASC stroke risk score of 2 or above are at a much higher risk of having a stroke than the general population. Anticoagulation therapy can help to prevent strokes by reducing the likelihood of a blood clot forming. A person's bleeding risk should be taken into account in reaching a decision about anticoagulation, although for most people the benefit of anticoagulation outweighs the bleeding risk.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults with non‑valvular atrial fibrillation and a CHA2DS2‑VASC stroke risk score of 2 or above are offered anticoagulation.

Data source: Local data collection.

Process

Proportion of adults with non‑valvular atrial fibrillation and a CHA2DS2‑VASC stroke risk score of 2 or above who receive anticoagulation.

Numerator – the number in the denominator who receive anticoagulation.

Denominator – the number of adults with non‑valvular atrial fibrillation and a CHA2DS2‑VASC stroke risk score of 2 or above.

Data source: Local data collection. Data can be collected using the NHS Quality and Outcomes Framework indicator AF007.

Outcome

Stroke rates in adults with a primary diagnosis of non‑valvular atrial fibrillation.

Data source: Local data collection. Data can be collected using the Royal College of Physicians' Sentinel Stroke National Audit Programme (SSNAP), question 2.1.

What the quality statement means for different audiences

Service providers (primary, secondary and tertiary care services) have written clinical protocols in place to ensure that anticoagulation is offered to adults with non‑valvular atrial fibrillation and a CHA2DS2‑VASC stroke risk score of 2 or above.

Healthcare professionals offer anticoagulation to adults with non‑valvular atrial fibrillation and a CHA2DS2‑VASC stroke risk score of 2 or above.

Commissioners (NHS England area teams and clinical commissioning groups) commission primary, secondary and tertiary care services with written clinical protocols to ensure that adults with non‑valvular atrial fibrillation and a CHA2DS2‑VASC stroke risk score of 2 or above are offered anticoagulation.

Adults with a type of atrial fibrillation called 'non‑valvular' who are identified by their doctor as being at higher risk of having a stroke are offered treatment with a medicine called an anticoagulant, to lower their risk of having a blood clot that could cause a stroke.

Source guidance

Atrial fibrillation: diagnosis and management. NICE guideline 196 (2021), recommendation 1.6.3

Definitions of terms used in this quality statement

CHA2DS2‑VASc stroke risk score

The CHA2DS2-VASc stroke risk score estimates the risk of stroke in people with non‑valvular atrial fibrillation. [Adapted from NICE's guideline on atrial fibrillation, recommendations 1.2.1 and 1.6.3]

Bleeding risk score

Bleeding risk, estimated using ORBIT bleeding risk score, should be taken into account when offering anticoagulation. The ORBIT bleeding risk score estimates the risk of bleeding.

Although ORBIT is the best tool for this purpose, other bleeding risk tools may need to be used until it is embedded in clinical pathways and electronic systems. [Adapted from NICE's guideline on atrial fibrillation, recommendation 1.2.2]