Introduction

1. Welcome to AF Revalidation

When viewing the lecture please use the controls to pause, scan and to enlarge the video to full screen.

Dr Wolff and Dr Fay introduce the AF Revalidation tool for GPs, highlighting the goals of the project, how it helps GPs and why AF is an ideal topic for the preparation of revalidation portfolio content.

My name is Andreas Wolff, I’m a GP principal in Darlington, also a GPwSI in Cardiology, caring for patients with heart rhythm disorders.  I work at the Westcliffe Cardiology Service.

I’m Dr Matthew Fay, I’m a GP based in Shipley which is north of Bradford.  I’m a GP with a Special Interest in Cardiology, particularly in the area of arrhythmias.
The consequences of undetected atrial fibrillation, and also under-treated AF, are huge.  It is estimated that 5,500 lives could be saved by adequate stroke prevention, and 15,00 stokes prevented.

AF requires more attention in general practice because we’re in a situation where many of the patients suffering from atrial fibrillation aren’t identified, many of those who are identified are suffering with symptoms of their arrhythmia, and a very large proportion of those at risk of stroke fro atrial fibrillation are actually unprotected; receiving oral antiplatelet agents such as aspirin, rather than the much more effective oral anticoagulants.

There have been a number of barrier to effective stroke risk reduction in atrial fibrillation.  One factor is that the risk of haemorrhage associated with the traditionally used anticoagulant, warfarin, has been greatly over estimated.  Also, it has been assumed that antiplatelet agents such as aspirin are effective stroke prevention in atrial fibrillation, which is actually not the case.  It has also been assumed that antiplatelet agents are safer, compared with anticoagulation, and that is not the case either.  So there have been a number of misconceptions which have led to anticoagulation not being used, and antiplatelet agents have been used instead of anticoagulation.

The goals of the revalidation training tool can be seen on different levels.  Firstly we are here to help the GPs to develop their revalidation portfolio.  We are here to try and improve the identification of people suffering with AF, and also risk stratifying them appropriately to prevent stroke.  We’re here to dispel the myth that aspirin is an effective therapy to prevent stroke in AF.  We are here to endorse the use of an oral anticoagulant in all those at risk.  And we’d like to be able to demonstrate to doctors how they have achieved that by using the GRASP-AF audit tool, which is freely downloadable from the NHS Improvement website.

AF is an ideal condition, which lends itself to be audited for the purposes of revalidation.  First of all, every practice has enough AF patients but still a number which is manageable.  So, for example, if you have an average 10,000 patient practice you will have around 200 AF patients.  About 100 of those will have to be looked at in terms of better stroke prevention.  So that’s a manageable figure and, because the stroke risk is so high, by treating a relatively small number of patients you can very quickly see the benefit in stroke risk reduction.

Please find below additional resources that you might find useful when learning about stroke prevention in AF

GRASP the initiative

A report from October 2012 on the practicalities of GRASP-AF and its benefits for primary care practitioners.  The report incudes a national summary of GRASP-AF patient treatment and a series of recommendations for commissioners and practitioners on the how stroke risk among AF patients can be reduced.
Report download

The AF Report

An expert report on AF and the prevention of stroke in the UK.  The AF Report was written for a general audience and presents a thorough and current distillation of the evidence and issues in AF stroke prevention.  The report also identifies current challenges and areas where action is needed to improve the care of AF patients. Download report

The AF Stroke Risk Calculator

A simple online tool for the calculation of CHADS2 and CHADSVASc scores for AF patients.  The calculator was designed to be intuitive and sufficiently easy-to-use for patients to calculate their own risk of stroke.

NHS IQ: GRASP-AF

The NHS Improving Quality website contains a wealth of helpful, practical information on GRASP-AF

The videos

Below are video clips from Dr Matt Fat and Dr Andreas Wolff on several aspects of AF patient care and the reduction of stroke risk.