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Saving money, saving lives in stroke prevention

Atrial fibrillation is putting a huge burden on the NHS. The condition, which causes an irregular and often abnormally fast heart rate, increases the risk of stroke by up to five times, and is estimated to cause around 12,500 strokes each year.

But around 7,000 strokes and 2,000 premature deaths could be avoided every year through effective detection and protection with anti-coagulant drugs, says Professor Mark Baker, NICE’s Director of Clinical Practice. “Unfortunately only half of those who should be getting these drugs, are,” he adds. “This needs to change if we are to reduce the numbers of people with AF who die needlessly or suffer life-changing disability as a result of avoidable strokes.”

One potential solution has come in the form of an industry-funded nationwide clinical review of atrial fibrillation (AF) patients. The review has resulted in an estimated saving to the NHS of around £82 million pounds in first year costs alone based on figures just by the Stroke Association, due to the prevention of around 1,800 strokes and hundreds of deaths.

Carried out during 2,000 audits by clinical pharmacists, the reviews of over 282,000 AF patients were based on NICE guidelines for AF, and highlighted groups of “at risk” patients. Each review stratified patients who required anti-coagulant medication or VKA therapy, needed their existing medication adjusting, were not adhering to their treatment regime or required secondary care referral to a haematologist. GPs were then able to prescribe preventative medication to those identified of being at risk of stroke whilst the clinical pharmacists carried out existing medication reviews to ensure that each patient was receiving optimum treatment therapy.

“This type of clinical review, which is funded by industry and therefore doesn’t place any burden on the NHS, clearly demonstrates how the pharmaceutical industry can play a huge part in the long term future of patient health,” said Mike Drakard, CEO of Leeds based Interface Clinical Services, an organisation working in partnership with both GP practices and pharmaceutical companies who provided the pharmacists for the audits. “This is one of the largest projects we have undertaken and based on NICE’s figures, we believe that it has already prevented more than 1,800 strokes and hundreds of deaths.

“According to the Stroke Association’s latest report1, the cost of treating a stroke in the first 12 months is now £45,409 whilst each subsequent year is estimated at £24,778 for rehabilitation and community support. Based on this we can conservatively estimate a saving of almost £82 million for the NHS taking into account the initial 12 months alone without considering the huge follow on costs which can continue for many years.”

Drakard adds that their team of clinical pharmacists are already helping to deliver similar programmes to this across the UK. “We believe this type of partnership is a strong model for helping to manage many long term health conditions including diabetes, COPD, asthma and heart failure for example.”

Mike Farrar, who was CEO of the NHS Confed and worked in the NHS as a senior manager for more than 20 years, adds: “This type of exercise is great for patients and the NHS in terms of outcomes and savings. As long as the data and prescribing decision is always under the control of the GP, these partnerships should be encouraged.”

“This has been hugely beneficial to AF patients at our practice,” says Dr John Wearne, a GP from Cheshire who has taken part in the review commented. “The pharmacist analysed our data and identified the patients that we then reviewed between us. We simply don’t have the time or resources to undertake a patient review of such complexity so we found their input invaluable. The industry support which made this possible is the type of industry partnership which really is beneficial, helping us to deliver high class, patient centric care.”

The clinical review of 282,000 patients began in 2013 and is still ongoing. The percentage of patients identified as at high risk of stroke has remained steady over the four year period to date (mean=92.02%) and the percentage of those high risk patients not receiving appropriate oral anticoagulant treatment has decreased from 35% to 24%. Due to the increase in patients on appropriate AF treatment, the review is continuing to prevent large numbers of strokes, with an estimated 545 being prevented in the last 12 months alone.

View this article as it appeared in the PharmaTimes

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