5. Facilitating audit with GRASP-AF

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Dr Fay and Dr Wolff introduce GRASP-AF and how it automates and facilitates clinical audit.

The implication of Professor Lip’s presentation for the average GP practice is that you will have about a quarter of your atrial fibrillation population inappropriately on aspirin.

These patients need to be reviewed and their risk re-evaluated and ideally their treatment needs to be changed from an antiplatelet agent to an anticoagulant.

The GRASP‑AF tool was developed by an arrhythmia nurse in Leeds, and is a simple audit that exploits the MIQUEST searches of our GP clinical systems to look at the care for people with atrial fibrillation.  In its fundamentals what it does is it looks for the population of AF sufferers, it then uses the CHADS2, or CHA2DS2‑VASc, schema to risk stratify those patients, and then it demonstrates that to us on a desktop where we can see those patients who are at risk, who are on an anticoagulant, those on aspirin or those receiving nothing.  It also quite nicely demonstrates how many strokes per year we should expect within out AF population if we maintain the status quo.  The tool has been developed by NHS Improvement so that it is easy to use, it is well supported by the tea.  So if you have any issues running the search, you can easily get assistance from the national team to make sure you get the results you require.  And it is housed by PRIMIS+ so that data which is uploaded can be used to appropriately direct the national team to make sure that the resources required for the management of patients in AF are provided.

When you consider revalidation as a general practitioner, part of that is around audit.  Audit is a great idea but building the searches and the tools to be able to achieve audit can actually take quite a while and distract from the more clinically-interesting part of interacting with patients, to achieve a good outcome.  GRASP‑AF is a ready-made audit tool which is easily downloaded from the NHS Improvement website, which allows you to audit your process, paying more attention to patient care than to tinkering with searches on the computer.

By using this newly-developed revalidation tool, GPs can future proof their care of atrial fibrillation patients, as the GRASP‑AF tool will automatically offer the option of the CHA2DS2‑VASc scoring tool, and gives you the option of using either CHADS2 or CHA2DS2‑VASc; which will address future developments in the NICE guidelines.

When considering using GRASP‑AF, the first thing that you need to do is ensure that you’ve downloaded the newest version. You might have downloaded a previous version and not got around to using it yet, and the new version allows you to toggle between the CHADS2 and CHA2DS2‑VASc schema, allowing you a little bit of flexibility in what you may want to do with your patients. Once you’ve downloaded it, running it is actually very simple, and it comes with a very easily followed instruction set.  Once it is run, it is important to save your data in a separate file, because next time you run the GRASP‑AF tool, it will overwrite the previous searches.  So if you want to ensure how you are performing, and close the audit loop, it is important to keep saving each individual search separately.  As a member of the national team looking after GRASP‑AF, I would also ask GPs to ensure the data is uploaded for us to be able to look at it on the national level. The uploaded data is anonymised, however when you do this, you will be a level II user of PRIMIS+ which means that you can look at where your practice stands amongst local practices and also where your practice stands, in its attitude to AF, compared to the national picture.

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.


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.