PACE Atrial Fibrillation Audit 2006

1
PACE Atrial Fibrillation Audit 2006
Marc Lyon PACE Audit Co-Ordinator
2
Who is this?
3
Why Atrial Fibrillation?

• Forthcoming NICE Guidance
• 2006/07 Quality Outcomes Framework
• PACE Event Guidance
• Major cause of morbidity

4
NICE Audit Standards
5
2006/07 QoF Targets
6
PACE 2006 Audit Criteria

• Diagnosis of AF should be based on an ECG
• Patients should receive the correct stroke
  prophylaxis according to their risk
  stratification score

7
How was it carried out?

• Identify AF patients
• Sample 5 for every 1000 practice population
• Collect data around stroke risk indicators,
  current medication and any contraindicating
  factors
• Audit Facilitators available for those practices
  unable to collect their own data
• Anonymous codes used to identify practices

8
Results

• Results returned so far-

Total Bradford City tPCT Patients 273
9
Age Distribution City tPCT
10
Diagnosis by ECG by Practice
11
Stroke Risk Stratification
12
No medication by Practice ()
13
Patients with CHAD2 0

• Low Risk of Stroke ideal aspirin
• 34 (12.5) patients in PCT figures
• 9 (26.5) on aspirin
• 2 contraindicated for aspirin
• 1 on clopidogrel (further 2 on clopidogrel with
  no recorded contraindications)
• 1 also contraindicated for clopidogrel and
  warfarin
• 7 (20.6) on warfarin
• 14 (41.2) on no medications

14
Patients with CHAD2 gt2

• High Risk of Stroke ideal warfarin
• 172 patients (63.0) in PCT figures
• 34 (19.8) on warfarin only
• 67 (39.0) on aspirin only
• Further 14 (8.1) on warfarin with aspirin
  contraindicated
• 5 (2.9) contraindicated for warfarin
• 2 on aspirin,
• 2 contraindicated for all 3,
• 1 on no other meds
• 44 (25.6) on no meds with no contraindications

15
Patients with CHAD2 1

• Intermediate Risk of Stroke clinical judgement
• Old guidance had low risk category
• 67 (24.5) patients in PCT figures
• 25 (37.3) on aspirin
• 12 (17.9) on warfarin
• 8 (11.9) contraindicated aspirin
• 7 on warfarin (2 contraindicated clopidogrel)
• 1 on clopidogrel
• 3 (4.5) contraindicated warfarin
• 1 on aspirin, 1 on clopidogrel, 1 on no other
  medication
• 14 (20.9) on no meds with no contraindications

16
CHAD2

• Only 1 patient scored 6
• 82yo female, aspirin only no other recorded
  contraindications
• 5 patients scored 5
• 4 on aspirin, 2 on warfarin, 1 on no meds none
  have contraindications recorded
• 145 (53.1) patients had hypertension Bandolier
  suggests 57
• 66 (24.2) patients had diabetes Bandolier
  suggests 10

Bandolier http//www.jr2.ox.ac.uk/bandolier/boot
h/AF/prevUK.html
17
Anecdotal Observations

• Not all contraindications are recorded as such
• Ethnicity Recording
• Not all patients have record of ECG even if they
  obviously have had one
• OTC aspirin therapy not always recorded even
  when notes suggest
• Secondary care warfarin clinics

18

• Any questions??