Atrial fibrillation: register

Indicator type

General practice indicator suitable for use in the Quality and Outcomes Framework.

Rationale

There is evidence that people with resolved atrial fibrillation (AF) remain at higher risk of stroke or transient ischaemic attack (TIA) than people without AF and continue to benefit from anticoagulation therapy (see Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies. Adderley et al. 2018).

Under the current business rules for the Quality Outcomes Framework (QOF), people coded as having resolved AF are removed from the AF register. They are therefore also excluded from the associated indicators intended to help prevent people with AF having a stroke or TIA. Adderley et al. (2018) found the proportion of patients with AF with any recorded AF resolved clinical code was 7.8%. The 2016 to 2017 QOF data report approximately 965,000 people on the AF register, this suggests that around 75,000 have an AF resolved code – about 10 people per GP practice in England (75,000 divided by 7,500). This indicator aims to extend the register to include those with resolved AF. QOF data for 2022 to 2023 report approximately 1,329,450 people on the AF register; this suggests that around 103,697 have an AF resolved code – about 16 people per GP practice in England (103,697 divided by 6,378).

Source guidance

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

Specification

A register of patients with a diagnosis of atrial fibrillation, including patients with 'AF resolved'.

Exclusions: None.

QOF data for 2022 to 2023 (indicator AF001) shows that 2.1% of people in England are on the atrial fibrillation register: 213 patients for an average practice with 10,000 patients. To be suitable for use in QOF, there should be more than 20 patients eligible for inclusion in the denominator, per average practice with 10,000 patients.