What is an arrhythmia?
An arrhythmia is an abnormality of the heart's rhythm that disturbs the electrical impulses which regulate the heart.
Cardiac arrhythmia affects more than 700,000 people in England and is consistently in the top ten reasons for hospital admission, using up significant A&E time and bed days.
The most common arrhythmia is atrial fibrillation (AF) which affects up to 1 percent of the population (rising to 4 percent in the over 65s) and absorbing almost 1 percent of the entire NHS budget.
Chapter 8 of the NSF
Chapter eight of the National Service Framework (NSF) for Coronary Heart Disease (CHD) was launched in 2005 and sets out three quality requirements and twenty markers of good practice to support improvements in services for arrhythmias and better prevention of sudden cardiac death.
Current arrhythmia work
ICD deactivation guidelines
January 2013 - The Network has published its Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life. Deactivating an ICD means 'turning off' the shocking function of the defibrillator so that a patient is not unnecessarily 'shocked' in the last minutes of life. The ICD will continue to provide bradycardia (slow heart rhythm) support should the patient need it but will no longer provide lifesaving therapy in the event of a ventricular tachyarrhythmia.
London Cardiovascular Project
We have focussed on delivering the arrhythmia part of the London Cardiovascular Project as well as work on syncope, inherited cardiac conditions and sudden cardiac death.
National priority projects
In response to Chapter eight of the National framework for coronary heart disease, arrhythmias and sudden cardiac death, the NHS Heart Improvement Programme established national priority projects in atrial fibrillation.
These projects were created against the backdrop of the 2006 NICE publication, Atrial fibrillation: The management of atrial fibrillation costing report, which highlighted that amongst patients with recognised AF, 46 per cent of those who would benefit from warfarin are not receiving it. Out of an estimated 355,000, only 189,000 were actually receiving warfarin.
Stroke prevention: Addressing atrial fibrillation in primary care
Through a National Priority Project, the SLCSN looked at increasing stroke prevention through the identification and management of atrial fibrillation in primary care.
The project aimed to:
- provide a strategic vision for improving and redesigning care for AF patients
- improve patient experience and ensure the timely and accurate diagnosis and treatment of AF
- support the appropriate transition of care between primary, secondary and community, ensuring provision of a streamlined and efficient AF care pathway
- support the development / commissioning of local arrhythmia services in line with evidenced based practice and healthcare for London review outcomes
The SLCSN worked to create a sector wide approach to optimising therapy for atrial fibrillation patients in primary care. This case study summary provides an overview of the work achieved by the end of April 2009. The tools and resources made available by all AF projects may be accessed from the NHS Improvement Web site.
Atrial fibrillation (AF) is a major predisposing factor to stroke, with 16,000 strokes annually in patients with AF, of which approximately 12,500 are thought to be directly attributable to AF.