Atrial fibrillation: register

Indicator

The contractor establishes and maintains a register of patients with atrial fibrillation, including patients with ‘AF resolved’.

Introduction

Atrial fibrillation (AF) is a condition of the heart causing it to beat rapidly and irregularly. People with AF are at increased risk of blood clots and stroke. The risk of these complications can be minimised through appropriate use of anticoagulation therapy.

This statement covers a new indicator that is part of the NICE menu of indicators for general practice, following the recommendations of the NICE indicator advisory committee in August 2018.

Resource impact

There are around 55.3 million people in England (Office for National Statistics, 2016). The latest data available (NHS Digital, 2017) indicate that the diagnosed prevalence of AF is 1.84%, equivalent to around 1,017,000 people in England and that of these people, 7.8% are recorded as ‘AF resolved’ (Adderley et al., 2018). This is equivalent to around 79,300 people in England.

Adding these people to the register of people with AF will result in additional costs which may include a GP review and future monitoring and treatment costs alongside possible savings through avoiding future AF related strokes.

Current data on the treatment of people with an ‘AF resolved’ code is not available.

However, an illustrative example shows that providing anticoagulant therapy and an annual review for this therapy for each 5% of the increased population (3,966 people) is estimated to cost around £1.9m, as shown in table 1. This excludes any savings from reduced adverse events which may be achieved as a result of the additional care provided to this group.

Table 1 Illustrative example showing estimated annual cost of providing anticoagulation therapy and an annual review for 5% of the eligible population

Category	Proportion	Population	Unit cost (£)	Total (£)
England population	-	55,268,067	-	-
Prevalence of diagnosed AF (all ages)	1.84%	1,016,932	-	-
Proportion with 'AF resolved'	7.80%	79,321	-	-
Proportion receiving additional anticoagulant therapy and annual review	5%	3,966	-	-
Annual review	-	3,966	40.00	158,600
Anticoagulant therapy	-	3,966	444.26	1,762,000
Total cost per 3,966 people	-	-	-	1,920,600

This assumes people receive anticoagulation therapy for 1 year (cost based on a weighted average from the costing template for CG180 Atrial fibrillation: management, updated to current cost from NHS drug tariff and including monitoring costs) and an annual review which includes a GP consultation (PSSRU, 2017), 5 minutes of practice nurse time (PSSRU, 2017) to take blood samples for testing and 3 blood test (Reference costs 2016-17, NHS Improvement). Costs will differ when healthcare professionals other than GPs carry out the review.