Atrial fibrillation (AF)

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a major risk factor for stroke.

The annual risk of stroke is five to six times greater in AF patients than people with a normal heart rhythm

A recognition and proper treatment of AF is important as strokes due to AF are preventable

We are working with health care organisations in South London to improve the identification and management of AF

Atrial fibrillation pathway for primary care - Note: Guidelines will be soon updated and posted on the London Strategic Clinical Networks website (autumn 2014)

The new SLCSN AF pathway was developed with the aim of providing consistent guidance for general practice across the sector.

Production of the pathway involved consultation with GP leads from across all South London PCTs, arrhythmia consultants and arrhythmia nurse specialists from all hospitals in South London.

The pathway was agreed and signed off at the South London Arrhythmia Clinical Round Table on 11 January 2012.

The pathway and associated documents can be downloaded here:

Stroke prevention: Addressing AF

We have been working with four pilot sites across South London through a National Priority Project (NPP) that aims to improve the idenfication and management of AF in primary care.

Whilst some aspects of this work is ongoing, lessons and resources have been identified for sharing in order to help replicate the success of this important project across other boroughs.

Learn more about this NPP and how you can focus on AF in your borough.

Resources on this site

Some of the tools available on this site to support project implementation include:

Identifying AF

  • Commissioning paper: Why address AF in the first place?
  • Patient awareness leaflets (e.g., Know your pulse)
  • Results from a local pilot, including pulse check into the flu clinic pro-forma

Diagnosing AF

  • Local AF pathway and FAQ supporting guideline
  • ECG economic modelling template
  • Telemedicine information

Treating AF

  • 10 steps before referring into secondary care
  • Tool to help decision making with patients regarding starting warfarin
  • GRASP-AF toolkit to allow treatment optimisation for existing AF patients
  • NPSA standards and audit tool
  • Modelling the impact of the new anticoagulants; consensus statement and guidance

A call to action: Background and rationale

Prevention of stroke is vital. The effect of stroke is significant - clinically, financially and socially:

  • Devastating and lasting impact to patients
  • High national prevalence of stroke 2.5%
  • 200,000 strokes per year
  • Large economical impact 2.8 billion direct costs to NHS
  • preventable through focus on prevention

What's the link between stroke and AF?

  • AF is a known risk factor for stroke. AF accounts for 14% of strokes, 18% in AF at time of stroke.
  • It increases risk and severity of stroke.
  • It is very common, affecting more than 600,000 people.
  • Identification and management of AF is sub-optimal.

What are the areas that must be addressed?

  • Increased identification of AF
  • Optimising treatment and management of AF
  • Review of existing AF services, particularly ECG and anticoagulation
  • Education

Potential impact

Anticipated benefits to your AF service include:

  • Improved access to timely diagnostics and anticoagulation
  • More patients managed/treated in primary care
  • Decline in inappropriate referrals into secondary care
  • Increased communication between primary and secondary care
  • Optimal treatment for all AF patients
  • Reduced service waiting times and access, where applicable
  • Reduced incidence of AF-related stroke

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In the news

New report shows better management of AF could save NHS millions of pounds every year - From Arrhythmia Alliance, 7 July
Download AA's latest newsletter

QOF set to boost numbers of AF patients on warfarin - From Pulse Today, 04 June

10 steps before you refer for AF
From the British Journal of Cardiology

Work stream structure

View the South London Arrhythmia work stream structure

Evidence update on AF

The 2010 Annual Evidence Update on Atrial Fibrillation has been released by NHS Evidence. The annual update contains significant advances in knowledge about atrial fibrillation.