North London Partners in health and care

Targeting atrial fibrillation to improve outcomes for patients with cardiovascular disease

Cardiovascular disease (CVD) is one of the biggest causes of premature mortality and morbidity in north central London (NCL). It is also a key contributor to health inequalities. Collaborative working by the north central London's Cardiovascular Disease prevention steering group which includes representatives from UCLPartners, Barnet, Camden, Enfield, Haringey and Islington Clinical Commissioning Groups (CCGs), public health and clinicians from primary and secondary care is improving CVD outcomes for residents' health and wellbeing.

Key to the programme's success is NHS England's investment into the five CCGs to mobilise virtual clinics within practices. This enables patients with known atrial fibrillation, an irregular heart rate, to be treated with appropriate medication to reduce strokes.

Cardiovascular disease (CVD) is one of the biggest causes of premature mortality and morbidity in NCL. It is also a key contributor to health inequalities. The north central London Cardiovascular Disease (CVD) prevention steering group sets the strategic direction locally to improve CVD outcomes for resident’s health and wellbeing.  

In 2018 the CVD prevention steering group decided to focus on optimising atrial fibrillation (AF) management, where patients with known AF are treated with appropriate medication to reduce strokes. To progress this workstream NCL (North London Partners) have been working collaboratively with UCLPartners, Clinical Commissioning Groups (CCGs), Public Health and clinical leads from primary care, in particular, to accelerate progress. 

Key to the NCL atrial fibrillation programme’s success is the NHS England investment into the five CCGs (Barnet, Camden, Enfield, Haringey and Islington) to take up the model successfully developed in Lambeth and Southwark and mobilise virtual clinics in all practices across NCL. Virtual clinics foster links with expert anticoagulant specialists that provides frontline clinicians including GPs, practice based nurses and pharmacists, an opportunity to discuss complex patients, initiate anticoagulants and build confidence to manage these patients. 

To ensure that our anticoagulation rates are sustained after the virtual clinic the following concurrent programmes are being supported: 

  • Real time atrial fibrillation dashboard produced from practices in NCL to monitor performance to enable early intervention and reduce variation in care
  • Clinical support to review atrial fibrillation pathways and education programmes, with the rollout of the NCL ABC of Cardiovascular practice based pharmacist training sessions and, education and training session on initiation and monitoring of direct oral anticoagulants to increase capacity in atrial fibrillation management.
  • Increasing access to clinical tool such as the clinical effectiveness group to enable practices to routinely monitor and action on their atrial fibrillation registry list.

In addition, we have been building local clinical leadership around atrial fibrillation management. Our CVD clinical lead facilitated the second NCL atrial fibrillation Workshop on “Optimisation after initiation” on the 23 May. It was exciting to see presentations from local leads including GPs, CCG leads, practice based pharmacists, specialist pharmacists, clinical leads and project managers. Our final workshop planned for Tuesday 1st  October will be focused on ensuring that we maintain the improvements around atrial fibrillation management, but also expanding our reach to look at hypertension management. 

We hope to continue to work closely with our NCL partnership to share the successes and lessons learnt in workshops throughout the programme.

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