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Each year in the UK, more than 100,000 people suffer a stroke.[1] Despite the often-avoidable nature of stroke, it continues to pervade our health and is the fourth biggest killer in the UK.[2]

A major risk factor for stroke is atrial fibrillation (AF); a condition where the heart beats irregularly and rapidly, significantly increasing the risk of stroke by up to five times.[3],[4] Despite the risks that AF presents, diagnosis and appropriate treatment for people across the UK can be variable and consequently sub-optimal.

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A shocking 1.2 million people are diagnosed with AF every year and, worryingly, a further half a million are estimated to be living with the condition undetected.[5] This is despite the fact that people who suffer an AF-related stroke are more likely to die or suffer severe disability compared to any other type of stroke.[6]

The Academic Health Science Network (AHSN) programme – and its constituent AHSNs – has identified that by improving how we Detect, Protect and Perfect AF care and treatment, the NHS can improve diagnosis, increase treatment as recommended by the National Institute for Health and Care Excellence (NICE), and spread best practice across the health system.[7],[8]

Through the improvement of diagnosis of the condition, we can help to ensure patients receive appropriate treatment and optimise management for an individual’s AF.

Health is not a commodity, but as the former Chief Medical Officer, Dame Sally Davies said, health should be one of the primary assets of our nation.[9] For people with AF, the experience of care varies from place-to-place, undermining the country’s national asset and leaving many short-changed.

To compare one of the most deprived areas of England with one of the least highlights the socioeconomic association of undiagnosed AF. For example, in Bradford City Clinical Commissioning Group (CCG), 48% of people are estimated to have undiagnosed AF; compared to Guildford and Waverley CCG where just 15% of people live with undiagnosed AF.[10],[11]

AF-related stroke risk can be reduced by up to two thirds with the use of anticoagulants[12],[13] yet these continue to be under-prescribed in the UK with around a quarter of eligible patients with AF not receiving NICE-recommended anticoagulant drugs.[14]

The NHS Long Term Plan (LTP) also suggests that digital technology, as well as better working with the voluntary sector, employers, the public sector and NHS staff will enable improvement in patient awareness, and therefore, management of ‘ABC’ (AF, blood pressure and Cholesterol).[15]

However, concerns about how to incorporate new consumer health technologies into the patient pathway[16] suggest a reticence to empower patients’ self-management of their condition.

Not only does AF come with significant human cost but the impact of stroke on the wider economy and, importantly, our NHS, compounds current resource pressures. Ensuring the sustainability of the NHS requires us to get ahead of this threat and find ways to prevent the financial and personal costs of stroke.

By addressing these wider health system challenges in collaboration with the NHS, and taking advantage of emerging consumer technologies, we’re hopeful the goals of the LTP can be met and the future of the UK’s heart health, and of the NHS, can be secured.

World Stroke Day is just one day of the year, but can be an important first step to raising awareness of the impact of AF. This begins a process that can lead to an end to the variations in treatment of AF and improvements in the diagnosis and appropriate treatment for people across the country.

The NHS LTP sets an ambition to prevent 150,000 cardiovascular disease events in the coming decade[17], but the challenge of this demands we take immediate steps. Put simply, the future is calling for action now and it’s this insight that shapes Daiichi Sankyo’s ambition to work collaboratively and become the Partner of Choice for the NHS to prevent people from suffering an AF-related stroke.

Manuel Reiberg, Managing Director of Daiichi Sankyo UK

[1] National Institute for Health and Care Excellence. NICEimpact stroke. Available at: https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/measuring-uptake/NICE-Impact-stroke.pdf. Accessed October 2019

[2] Stroke Association. State of the nation. Stroke statistics. February 2018. Accessed at https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2018.pdf. Accessed October 2019

[3] Ibid

[4] NHS England. The NHS Long Term Plan. Accessed at https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/. Accessed October 2019

[5] Stroke Association. State of the nation. Stroke statistics. February 2018. Accessed at https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2018.pdf. Accessed October 2019

[6] NHS England. Atrial fibrillation demonstrator site programme. Accessed at https://www.england.nhs.uk/ourwork/clinical-policy/cvd/af-demonstrator-site-programme/. Accessed October 2019

[7] Academic Health Science Network. Atrial fibrillation. Detect, protect and perfect. Accessed at https://www.ahsnnetwork.com/about-academic-health-science-networks/national-programmes-priorities/atrial-fibrillation. Accessed October 2019

[8] The King’s Fund. Improving diagnosis and treatment for atrial fibrillation. Accessed at https://www.kingsfund.org.uk/publications/innovation-nhs/improving-diagnosis-atrial-fibrillation Accessed October 2019

[9] Dame Sally Davies. Annual Report of the Chief Medical Officer, 2018. Health 2040 – Better Health Within Reach. Accessed at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/767549/Annual_report_of_the_Chief_Medical_Officer_2018_-_health_2040_-_better_health_within_reach.pdf. Accessed October 2019

[10] [Deprivation data] Ministry of Housing, Communities & Local Government. The English Indices of Deprivation 2019 (IoD2019). Statistical Release: 26 September 2019. Accessed at https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019. Accessed October 2019

[11] [Undiagnosed AF data] NHS Rightcare and Imperial College Health Partners. Atrial fibrillation high impact intervention tool. Bradford City CCG and Guildford and Waverley CCG profiles. Accessed at http://afhiit.imperialcollegehealthpartners.com/afimpact. Accessed October 2019

[12] Sentinel Stroke National Audit Programme (SSNAP). SSNAP Annual Public Report: National results June 2019. Accessed at https://www.strokeaudit.org/Documents/National/Clinical/Apr2017Mar2018/Apr2017Mar2018-AnnualReport.aspx. Accessed October 2019

[13] Adderley NJ, et al. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart 2019;105:27–33. Accessed at https://www.ncbi.nlm.nih.gov/pubmed/29991504. Accessed October 2019

[14] Stroke Association. 2018. State of the Nation. Available at https://www.stroke.org.uk/system/files/sotn_2018.pdf. Accessed October 2019

[15] NHS England. The NHS Long Term Plan. Accessed at https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/. Accessed October 2019

[16] Royal College of Surgeons. Advances in health tech could send “worried well” into hyperdrive, warns leading surgeon. 14 September 2018. Accessed at https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/worried-well-hyperdrive/. Accessed October 2019

[17] NHS England. The NHS Long Term Plan. Accessed at https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/. Accessed October 2019