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<p>NHS England is encouraging clinical commissioning groups to work with local practices
to target people at risk of atrial fibrillation (AF). Innovative approaches such as
pulse testing at flu clinics and by some dentists are being used to identify AF in
older people. The NHS Health Check programme’s best practice guidance also recommends
a pulse check is carried out as part of the process of taking a blood pressure reading.
People found to have an irregular pulse rhythm should be referred to the general practitioner
for further investigation.</p><br /><p>The National Institute for Health and Care
Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based
advice on the care and treatment of people with AF and includes recommendations on
diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In
addition to its clinical guideline on AF, NICE has published technology appraisal
guidance on a number of new oral anticoagulants (NOACs), approving them for certain
patients.</p><br /><p>There is a legal requirement on commissioners to provide funding
for treatments and drugs recommended in NICE technology appraisal guidance within
three months of the guidance being published.This is enshrined in the NHS Constitution
as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64"
target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake"
target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s
updated guideline in June 2014. This addresses some of the barriers to implementing
NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation
and strengthen compliance of the uptake of NICE technology appraisals was identified
in <em>Innovation Health and Wealth</em>, published in December 2011. In response,
NHS England and the Health and Social Care Information Centre now publishes on a quarterly
basis an Innovation Scorecard to enable commissioners to benchmark their own position
and increase transparency to patients and the public. This assists the NHS in the
identification of variation and the adoption of treatments such as NOACs that are
recommended in NICE technology appraisals. In addition, NHS England advises that it
expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some
progress is being made. The uptake of NOACs across England has doubled in recent years
from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br
/><p><del class="ministerial">No assessment has been made of the number of strokes
related to AF could be prevented each year through the roll-out of Guidance on Risk
Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However,
in 2014, an economic analysis estimated that if all eligible patients at high risk
were managed according to the NICE AF guidelines, an additional 11,600 AF related
strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies
of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial">No
assessment has been made of the number of strokes related to AF could be prevented
each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention
for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic
analysis estimated that if all eligible patients at high risk were managed according
to the NICE AF guidelines, an additional 11,600 AF related strokes per year could
be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies
of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p>
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