• Charity identifies nearly 38,000 patients with atrial fibrillation who have poor control of their anticoagulation treatment
  • 15,000 patients admitted to hospital with an AF related stroke with almost half receiving no treatment despite known AF risk
  • Two fifths of NHS not recording data on patient treatment

Thousands of patients are being put at risk of preventable strokes leading to death and life long disability because of poor management by the NHS, HSJ has been told.

Research by the charity Anticoagulation UK has revealed more than 37,000 patients with heart condition atrial fibrillation had poor control of their anticoagulation therapy, which left them at an increased risk of a stroke or bleeding.

During 2016-17, there were 15,000 people admitted to hospital with an AF related stroke in England. Almost half of these patients were not receiving appropriate anticoagulation therapy despite being known to have AF before their stroke.

A further 20 per cent occurred in people who were being treated with an antiplatelet medicine only, which is not recommended by the National Institute for Health and Clinical Excellence.

Of these patients 26 per cent, or 1,838, died in hospital while almost half, 3,230, were discharged from hospital with a moderate or severe disability.

In an interview with HSJ, Eve Knight, chief executive of the charity, said the poor performance was a “huge patient safety issue for the NHS”.

She said: “The cost is enormous and that’s just a monetary cost. The cost to the patient, their family and their quality of life is unquantifiable. Unless someone from NHS England gets a grip of this, more people will go on having bleeds, and strokes and in fact die.

“Their whole lives can be completely devastated, and it is absolutely preventable.”

It is estimated that AF related illness including strokes, costs the NHS over £2.2bn a year and treatment varies. People with AF have a five fold increased risk of stroke when compared to people with a normal heart rhythm.

Analysis by NHS England and Public Health England has previously said up to 14,000 strokes could be avoided over a three year period if AF was diagnosed and properly treated with anticoagulation drugs. This could save the NHS £240m a year.

Anticoagulation UK sourced data from more than 90 NHS trusts about their treatment of AF patients. It found more than two fifths of trusts did not routinely collect data on how often patients were within their therapeutic range. This is the level at which the drugs are effective for each individual patient.

It also found only six investigations into incidents resulting from poor anticoagulation treatment during a 12 month period.

The charity also found 62 per cent of trusts had no written protocols for reassessing patients with AF who are known to be regularly outside their therapeutic range.

One in 10 trusts told the charity they provided no information or support for AF patients.

Ms Knight told HSJ: “Trusts are not routinely collecting the most basic data about the time patients spend within their therapeutic range so how do they know how many patients are at risk and how do CCGs, who are funding this, know what they are actually paying for?

“Quite frankly if a patient is not in range it should be listed as an adverse event, there should be a root cause analysis and you learn from it. It’s a very casual way of dealing with what are in effect, very dangerous drugs.

“We do need some kind of top down approach that sets out standards of what needs to be done and which says what an excellent anticoagulant service looks like.”

The charity’s report was supported by MHP Health communications which was funded by Bayer UK but editorial control remained with the charity.

Dr Matt Kearney, national clinical director for cardiovascular disease prevention, said: “NHS England and Public Health England are working together to identify more people who have high risk conditions such as atrial fibrillation or high blood pressure so the NHS can provide early treatment to prevent potential strokes and heart attacks.

“Recent evidence published shows there has been substantial improvement with around 7,000 strokes being prevented across Britain each year, thanks to better recognition of atrial fibrillation. And, to help GPs, we have also recently distributed 6,000 mini electrocardiogram devices that clinicians can use with mobile phones to detect atrial fibrillation.”