Nearly 92% of atrial fibrillation patients in England anticoagulated, says NHS adviser

Some 91.48% of patients with atrial fibrillation (AF) in England are now anticoagulated, which has been described as a “success story” in optimising treatment of patients with AF.

The figure was quoted at the Primary Care Pharmacy Association’s (PCPA) Leadership Conference in London on 19 November 2024 by Helen Williams, consultant pharmacist for cardiovascular disease (CVD) at NHS South East London Integrated Care Board (ICB) and NHS England national specialty adviser for CVD prevention.

In 2019, Public Health England (now the UK Health Security Agency) set a target of treating 90% of AF patients with direct-acting oral anticoagulant (DOACs) by 2029.

Following this, NHS England issued commissioning guidance recommending the use of the DOAC edoxaban (Lixiana; Daiichi Sankyo) as the most cost-effective option and announced in November 2023 that around 460,000 more people started taking anticoagulant drugs, achieving the government target.

In January 2024, NHS England revised its recommendation, advising prescribers to supply generic apixaban over edoxaban as a preferred DOAC for the treatment of AF in new patients.

Williams said in a statement to The Pharmaceutical Journal on 21 November 2024: “Meeting this ambition five years ahead of target is a great success story for patients and the NHS — by delivering anticoagulation to over nine in ten patients with atrial fibrillation, we are protecting them from fatal or disabling strokes.

“Pharmacy teams have been central to the delivery of this, and we are aiming to replicate this success in other areas by increasing the proportion of patients with high blood pressure treated and increasing the uptake of lipid-lowering therapies to drive further reductions in cardiovascular death, heart attacks and strokes.”

Community pharmacies in England made almost 150,000 interventions with patients taking oral anticoagulants in 2021/2022 and 2023/2024, according to two national anticoagulant audits aimed at identifying and addressing medication issues that could increase the risk of bleeding and harm to patients, which revealed a significant increase in patients with a yellow anticoagulant alert card.

Paul Wright, consultant cardiovascular pharmacist at Barts Health NHS Trust, said it was “great news” and represented “a huge improvement in optimisation for patients with atrial fibrillation”.

“The improvement is multifactorial and has been driven by the availability of DOACs (compared to warfarin), awareness compaigns, changes in treatment pathways, improved access to start anticoagulation in primary care and collaborative working across boundaries,” he said, adding that further work was being undertaken to improve detection.

Vicky Ruszala, lead pharmacist for cardiology at North Bristol NHS Trust, added: “It’s been a real push and actually it’s been primary care that has owned this, which really does show the benefit of primary care involvement in this kind of management.”

She said that clear prescribing guidelines and evidence of benefit had enabled the primary and secondary care workforce to push in the same direction. “Now we’ve got everyone on them, it’s about using them well and making sure we follow all the safety protocols,” she explained, by ensuring patients are on the correct dosage.

Frances Akor, consultant pharmacist in anticoagulation at Imperial College Healthcare NHS Trust, told The Pharmaceutical Journal that the proportion of AF patients receiving anticoagulants is “far exceeding initial expectations”.

“Aligning targets such as QOF [the National Institute for Health and Care Excellence’s (NICE) ‘Quality and Outcomes Framework’] with the [NHS] Long-term plan and NICE AF Guideline [‘Atrial fibrillation: diagnosis and management’], together with the successful rollout of best value DOACs, alongside the huge efforts of the multidisciplinary primary care team with the support of secondary care has contributed to making this a reality,” she added.