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Atrial Fibrillation Association

Clinical Articles, Lead Article

GRASP the initiative

Commissioners and primary care clinicians must promote the effective use of the GRASP-AF (Guidance on Risk Prevention in Atrial Fibrillation) toolkit across the country, according to a report1 released recently by the Atrial Fibrillation Association (AFA).

The Grasp the initiative report supports the nationwide roll-out of the GRASP-AF tool, designed to be used by healthcare commissioners as well as clinical staff in primary care.

Trudie Lobban (CEO, AFA) said: “Its purpose is twofold: to offer an introduction to GRASP-AF and demonstrate the potential that this tool has in improving care for people with AF across England; and to provide a series of practical recommendations on what more can be done by commissioners and primary care clinicians…I would urge commissioners to recognise that every AF-related stroke costs on average £11,900 pounds in the first year and that the use of GRASP-AF could prevent up to 8,000 of these strokes every year.”

Dr Matt Fay (Medical Advisor, AFA) said: “The data collected through the use of the GRASP-AF tool, developed by NHS Improvement and hosted by PRIMIS+, shows that despite the clear advantage of anticoagulants over aspirin, a significant number of those who could benefit from this intervention are not currently receiving it.”


Trudie Lobban, CEO Atrial Fibrillation Association

“Clinicians, commissioners and NHS stakeholders now have to respond to the problems caused by the over-use of aspirin in the prevention of AF-related stroke. Many patients feel that stroke is a fate worse than death; yet they are not offered effective, evidence-based prevention in the form of an oral anticoagulant. GRASP-AF was designed for primary care clinicians to audit their intervention and make the appropriate changes in discussion with patients. Embracing anticoagulation in AF can significantly reduce the number of AF-related strokes suffered across the country,” he added.

Key recommendations for commissioners include:

  • Commissioners should provide proactive leadership by promoting the use of GRASP-AF to all GP practices in their area
  • Commissioners should support education for primary care professionals on AF and stroke risk, which should include guidance on the use of clinical audit tools such as GRASP-AF
  • Commissioners should consider using local quality improvement levers to encourage the use of GRASP-AF
  • Commissioners should offer IT support to GP practices to facilitate the uptake and effective use of GRASP-AF
  • Commissioners should work together with clinical networks and primary care professionals to put in place strategies to identify AF patients at risk of stroke who may benefit from anticoagulation, and increase the number of patients within this population who are appropriately treated.

Key recommendations for primary care professionals:

  • Primary care professionals should take the initiative: download, install and run GRASP-AF regularly
  • Primary care professionals should run GRASP-AF using the CHA2DS2-VASc score, rather than the CHADS2 score, for greater sensitivity
  • Primary care professionals should upload their GRASP-AF results onto CHART Online
  • Primary care professionals should attend education events and keep up to date with the latest clinical guidelines on the prevention of AF-related stroke.


1. Grasp the initiative: supporting the use of GRASP-AF in primary care to help reduce the risk of AF-related stroke. Atrial Fibrillation Association 2012. Available from

Published on: December 20, 2012

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