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64118

registered interest
date	25/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Heart Diseases
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what action they are taking to improve the diagnosis of atrial fibrillation.
tabling member printed	Lord Black of Brentwood
uin	HL622
answer	answer is ministerial correction date of answer 08/07/2014 answer text <p>NHS England is taking a number of actions to improve the care and management of people with atrial fibrillation (AF). It has published <em>Our Ambition to Reduce Premature Mortality: A resource to support commissioners in setting a level of ambition</em>, which identifies improved management of AF as a priority for reducing premature mortality. The resource can be found at:</p><p> </p><p>www.england.nhs.uk/ourwork/sop/red-prem-mort/</p><p> </p><p>National Health Service Improving Quality's <em>Living Longer Lives</em> programme includes promoting the use of a simple but effective audit tool called Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) which simplifies the process of identifying patients with AF who are not receiving the right treatment. NHS Improving Quality is currently collaborating with partner organisations, including charities, to support the nationwide roll-out of GRASP-AF.</p><p> </p><p>This work will be supported by the publication of an economic analysis commissioned by NHS Improving Quality using GRASP data which demonstrates both the current and potential impact of atrial fibrillation management on the number of AF related strokes.</p><p><em> </em></p><p>Discussions are also underway to consider whether opportunistic testing for atrial fibrillation (AF) should be encouraged nationally as part of the NHS Health Check programme.</p><p> </p> answering member printed Earl Howe grouped question UIN HL623 question first answered 08/07/2014 15:27:07 answering member 2000 label Biography information for Earl Howe
tabling member	4171 label Biography information for Lord Black of Brentwood

64119

registered interest
date	25/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Heart Diseases
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, in the light of the publication of the National Institute for Health and Care Excellence clinical guideline 180, what action they are taking to ensure appropriate risk stratification and uptake of anti-thrombotic therapy among patients with atrial fibrillation.
tabling member printed	Lord Black of Brentwood
uin	HL623
answer	answer is ministerial correction date of answer 08/07/2014 answer text <p>NHS England is taking a number of actions to improve the care and management of people with atrial fibrillation (AF). It has published <em>Our Ambition to Reduce Premature Mortality: A resource to support commissioners in setting a level of ambition</em>, which identifies improved management of AF as a priority for reducing premature mortality. The resource can be found at:</p><p> </p><p>www.england.nhs.uk/ourwork/sop/red-prem-mort/</p><p> </p><p>National Health Service Improving Quality's <em>Living Longer Lives</em> programme includes promoting the use of a simple but effective audit tool called Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) which simplifies the process of identifying patients with AF who are not receiving the right treatment. NHS Improving Quality is currently collaborating with partner organisations, including charities, to support the nationwide roll-out of GRASP-AF.</p><p> </p><p>This work will be supported by the publication of an economic analysis commissioned by NHS Improving Quality using GRASP data which demonstrates both the current and potential impact of atrial fibrillation management on the number of AF related strokes.</p><p><em> </em></p><p>Discussions are also underway to consider whether opportunistic testing for atrial fibrillation (AF) should be encouraged nationally as part of the NHS Health Check programme.</p><p> </p> answering member printed Earl Howe grouped question UIN HL622 question first answered 08/07/2014 15:27:07 answering member 2000 label Biography information for Earl Howe
tabling member	4171 label Biography information for Lord Black of Brentwood

64120

registered interest
date	25/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Anticoagulants
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many people in England are treated with (1) warfarin, and (2) novel oral anticoagulants each year.
tabling member printed	Lord Black of Brentwood
uin	HL624
answer	answer is ministerial correction date of answer 01/07/2014 answer text <p>Information is not held centrally on the number of people treated with warfarin or novel oral anticoagulants. The following table provides information on the number of prescription items written in England and dispensed in the community in the United Kingdom, for the latest calendar year, for apixaban, dabigatran etexilate, rivaroxaban, and warfarin sodium.</p><p> </p><table><tbody><tr><td colspan="2"><p>Prescription items written in England and dispensed in the community in the United Kingdom for 2013 <sup>1</sup></p></td></tr><tr><td><p>Medicine <sup>2</sup></p></td><td><p>Items (000s)</p></td></tr><tr><td><p>Apixaban</p></td><td><p>14.4</p></td></tr><tr><td><p>Dabigatran etexilate</p></td><td><p>174.0</p></td></tr><tr><td><p>Rivaroxaban</p></td><td><p>190.0</p></td></tr><tr><td><p>Warfarin sodium <sup>3</sup></p></td><td><p>11,022.8</p></td></tr><tr><td><p>Total for apixaban, dabigatran etexilate, rivaroxaban, and warfarin sodium</p></td><td><p>11,401.2</p></td></tr><tr><td><p>Percentage of warfarin sodium compared to the total for apixaban, dabigatran etexilate, rivaroxaban, and warfarin sodium</p></td><td><p>96.7%</p></td></tr></tbody></table><p><em> </em></p><p><em>Source:</em> ePACT and Hospital ePACT, NHS Prescription Services, part of the NHS Business Services Authority</p><p><em> </em></p><p><em>Notes:</em></p><p><sup>1. </sup>The figures include prescriptions written in a hospital in England but dispensed in the community in the United Kingdom.</p><p><sup>2. </sup>These medicines are also used in secondary care, however no equivalent measure to a prescription item is available for secondary care data.</p><p>Some patients treated with warfarin may receive prescription items for two or three different strengths of warfarin to allow the dose to be altered in response to monitoring of INR. (NB: warfarin is available as 0.5mg, 1mg, 3mg and 5mg tablets).</p> answering member printed Earl Howe grouped question UIN HL625 question first answered 01/07/2014 11:46:45 answering member 2000 label Biography information for Earl Howe
tabling member	4171 label Biography information for Lord Black of Brentwood

64121

registered interest
date	25/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Anticoagulants
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what percentage of the total number of prescriptive items for apixaban, dabigatran etexilate, rivaroxaban, and warfarin sodium in England were for warfarin sodium in the last year for which figures are available.
tabling member printed	Lord Black of Brentwood
uin	HL625
answer	answer is ministerial correction date of answer 01/07/2014 answer text <p>Information is not held centrally on the number of people treated with warfarin or novel oral anticoagulants. The following table provides information on the number of prescription items written in England and dispensed in the community in the United Kingdom, for the latest calendar year, for apixaban, dabigatran etexilate, rivaroxaban, and warfarin sodium.</p><p> </p><table><tbody><tr><td colspan="2"><p>Prescription items written in England and dispensed in the community in the United Kingdom for 2013 <sup>1</sup></p></td></tr><tr><td><p>Medicine <sup>2</sup></p></td><td><p>Items (000s)</p></td></tr><tr><td><p>Apixaban</p></td><td><p>14.4</p></td></tr><tr><td><p>Dabigatran etexilate</p></td><td><p>174.0</p></td></tr><tr><td><p>Rivaroxaban</p></td><td><p>190.0</p></td></tr><tr><td><p>Warfarin sodium <sup>3</sup></p></td><td><p>11,022.8</p></td></tr><tr><td><p>Total for apixaban, dabigatran etexilate, rivaroxaban, and warfarin sodium</p></td><td><p>11,401.2</p></td></tr><tr><td><p>Percentage of warfarin sodium compared to the total for apixaban, dabigatran etexilate, rivaroxaban, and warfarin sodium</p></td><td><p>96.7%</p></td></tr></tbody></table><p><em> </em></p><p><em>Source:</em> ePACT and Hospital ePACT, NHS Prescription Services, part of the NHS Business Services Authority</p><p><em> </em></p><p><em>Notes:</em></p><p><sup>1. </sup>The figures include prescriptions written in a hospital in England but dispensed in the community in the United Kingdom.</p><p><sup>2. </sup>These medicines are also used in secondary care, however no equivalent measure to a prescription item is available for secondary care data.</p><p>Some patients treated with warfarin may receive prescription items for two or three different strengths of warfarin to allow the dose to be altered in response to monitoring of INR. (NB: warfarin is available as 0.5mg, 1mg, 3mg and 5mg tablets).</p> answering member printed Earl Howe grouped question UIN HL624 question first answered 01/07/2014 11:46:44 answering member 2000 label Biography information for Earl Howe
tabling member	4171 label Biography information for Lord Black of Brentwood

64122

registered interest
date	25/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Anticoagulants
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what action they are taking to increase the uptake of novel oral anticoagulants in the management of atrial fibrillation.
tabling member printed	Lord Black of Brentwood
uin	HL626
answer	answer is ministerial correction date of answer 01/07/2014 answer text <p>Decisions on the prescribing of medicines are a matter for clinicians in discussion with their patients.</p><p> </p><p>National Health Service commissioners are legally required by regulations to fund those anticoagulant treatments recommended by the National Institute for Health and Care Excellence(NICE) in its technology appraisal guidance.</p><p> </p><p>The NICE Implementation Collaborative published a consensus statement on supporting the use of novel oral anticoagulants in non-valvular atrial fibrillation on 18 June 2014. This is available at:</p><p> </p><p>www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64</p><p> </p><p>NICE published its updated clinical guideline on the management of atrial fibrillation on 25 June 2014 which recommends that novel oral anticoagulants should be offered where appropriate.</p><p> </p><p>The latest data from the Innovation Scorecard show that uptake of new anticoagulants across England is increasing. Further information is available at:</p><p> </p><p>www.hscic.gov.uk/catalogue/PUB13669</p><p> </p> answering member printed Earl Howe question first answered 01/07/2014 11:47:28 answering member 2000 label Biography information for Earl Howe
tabling member	4171 label Biography information for Lord Black of Brentwood