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American Heart Association, Drs Matt Fay and Andreas Wolff

Clinical Articles, Featured

New programme to improve in-hospital atrial fibrillation care

This year, the American Heart Association will expand its Get With The Guidelines® quality improvement programme1 to improve care for patients hospitalised with atrial fibrillation (AF). Is the UK also keeping pace?

The Get With The Guidelines-Atrial Fibrillation programme will provide healthcare professionals a quality improvement blueprint for how best to care for AF patients, as well as a system for collecting valuable data. The data gives participating hospitals feedback on their practice and patient outcomes and can be used to develop new evidence-based guidelines for in-hospital care for AF patients.

“While scientifically proven therapies and approaches to treatment exist for patients with atrial fibrillation, wide gaps, variations and disparities remain in the quality of care for people with this common heart rhythm disorder,” said Dr Lee H Schwamm, chair of the Get With The Guidelines National Steering Committee (Harvard Medical School, Boston). “By improving the care of patients with atrial fibrillation through the Get With The Guidelines programme, we can save lives and prevent serious complications, such as stroke.”

Dr Paul Kalra

Dr Matthew Fay (Westcliffe Medical Centre
, 
North Bradford)

“Our Get With The Guidelines suite is the ideal home for a nationwide atrial fibrillation quality improvement module, because participation in these programmes has proven to make a difference in the quality of care and outcomes for patients with heart disease and stroke,” Dr Schwamm said. “In the last decade, numerous scientific studies have shown Get With The Guidelines participating hospitals are more likely to adhere to national guideline-recommended therapies than other US hospitals.”

Get With The Guidelines is the largest national hospital-based programme dedicated to quality of care improvement for patients with cardiovascular disease, including targeted initiatives in stroke, heart failure and resuscitation. More than 42% of US hospitals participate in the quality initiative, which has a database of nearly 5.5 million patient records.

A recent survey conducted by the American Heart Association/American Stroke Association found that about half of the patients who have AF have not been properly educated about their stroke risk. Along with the new Get With The Guidelines-Atrial Fibrillation programme, the association equips healthcare providers with resources to help them educate patients on the condition of atrial fibrillation and the link to stroke risk.

Additionally, the 2011 Annual Impact Report and infographic poster illustrate the breadth of the problem and how the organisation is working to close gaps in knowledge, understanding and treatment among healthcare providers and patients.

Dr Paul Kalra

Dr Andreas Wolff (Whinfield Medical Practice, Whinbush Way, Darlington)

What are the implications for UK practice?

Dr Matthew Fay, national lead for AF and stroke prevention, (Westcliffe Medical Centre
, 
North Bradford) spoke to BJC Arrhythmia Watch on the campaign: “The ‘Get With The Guidelines’ programme from AHA is a way to try to regiment the management of chronic cardiac conditions to maximise the use of preventive and symptom-controlling medication. It looks at the need to involve the whole multi-disciplinary team to ensure that the ethos of prevention of disease penetrates the organisation”.

Aspirin suboptimal for stroke prevention

“The inclusion of AF shows how increasingly this dominant stroke risk factor is being tackled around the world. In the UK such an approach could find difficulty as the national NICE guideline, published in 2006, now seems conservative in its approach to stroke prevention and even the more recent ESC guidance lags behind the Royal College of Physicians’ consensus statement, where the role of the aspirin in AF management has finally become part of medicine’s past rather than future.”

“However this may be a slightly purist attitude, with the national GRASP-AF audit, hosted by PRIMIS+ on behalf of the NHS Improvement, showing that of the 270,000 AF patients recorded only 50% of those conservatively  assessed as being at risk of stroke (CHADS2 score of 1 or greater) are currently receiving an anticoagulant.”

“In this setting, even aggressive adherence to the 2006 NICE guideline would dramatically reduce the incidence of AF related stroke in the UK, and would help change the attitude of clinicians where prevention of disease sometimes struggles to receive the attention it requires”.

Dr Andreas Wolff, another UK GP with a special interest in cardiology (Whinfield Medical Practice, Whinbush Way, Darlington), also spoke to BJC Arrhythmia Watch on the campaign: “Generally speaking I am in favour of campaigns like ‘Get With The Guidelines’ as there is ample evidence that just publishing a guideline doesn’t mean it will be read or even adopted. The situation in the UK is somewhat different as NICE is sort of mandatory. Many employers make doctors sign agreements that they will adhere to NICE guidelines.”

References

1. For more information, visit: www.heart.org/quality

Published on: August 24, 2012

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  • Atrial Fibrillation Association
 

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