Atrial Fibrillation Project, AF Pathway, NOAC Implementation Costings and Data Update- October 2014 ASHFORD CCG

Transcription

1 Atrial Fibrillation Project, AF Pathway, NOAC Implementation Costings and Data Update- October 2014 ASHFORD CCG

2 South East Coast SCN -Atrial Fibrillation Project Commissioning Recommendations Earlier detection of AF, such as opportunistic pulse screening GRASP-AF tool utilised by all GP practices Adoption of the new NICE Guidance (NG180- June 2014) on the management of AF in particular anticoagulation optimisation Use of primary care AF pathway. Secondary care pathway in development Information SES (HES) data from 2013 by CCG included NOAC prescribing by CCG included Costing by CCG of implementation of NICE Guidance currently being refined. Existing costing based on NICE guidance of 88p per head included Infographic: Atrial fibrillation at a glance No new QOF data in this pack 2013/14 data not available at present

3 GRASP-AF Tool Free risk stratification tool to identify patients on the GP register who have atrial fibrillation and are at risk of stroke

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5 NOAC and Warfarin Prescribing and NICE Calculated Cost of AF Guidance Implementation Surrey Quarter /14 Medicines Optimisation CCG Dashboard CCG Name Apixaban, Dabigatran etexilate & Rivaroxaban Items Apixaban, Dabigatran etexilate, Rivaroxaban & Warfarin sodium Items NOAC Indicator (ITEMS/ITEMS) % CCG Popultation '000 NOAC plus Warfarin sodium items per '000 population NOAC items per '000 population Annual Cost of NICE Implementation - 000's = 88p per head of population KENT NHS Ashford CCG 1,036 7, NHS Canterbury and Coastal CCG 1,234 4, NHS Dartford, Gravesham and Swanley CCG 1,082 12, NHS Medway CCG 1,708 18, NHS South Kent Coast CCG 1,569 3, NHS Swale CCG 488 5, NHS Thanet CCG 935 6, NHS West Kent CCG 2,510 32, TOTALS 10,562 90, ,

6 Data Secondary User Service (HES) 2013 Calendar Year South East Coast by CCG AF status of admitted strokes SEC average is 33.2 %. Range is 26.4 to 41.8% AF strokes average 42.2% of all stroke inpatient bed days in SEC. Range is 28.1 to 53.6% Readmissions within 30 days for AF strokes average 33.4% of total stroke readmissions. Range is 13.3 to 54.5 % Deaths during admission for AF stroke/all stroke deaths during admission average 56%. Range is 47 to 68.4% So AF Strokes in 2013 averaged 33.2 % of admitted strokes 42.2% of stroke bed days 33.4 % of stroke readmissions 56% of stroke deaths during admission Reflects higher morbidity and mortality of AF strokes Admissions to hospital with AF strokes as rate per 1000 in AF Practice Register Lower is good means that less patients with AF are being admitted with Stroke? Reflects better Stroke prevention such as use of anticoagulants Need to check against prevalence rates per CCG could mean that low numbers of patients are being registered - e.g. Brighton and Hove CCG quite low prevalence and high rate of admission compared to the average

7 Ischaemic Stroke Activity - Percentage with Atrial Fibrillation (actual number with AF as diamond on right-hand axis) Data for calendar year 2013 Source: Secondary Uses Service (SUS Admissions 45% Admissions KSS Admissions with AF % 35% % % 20% % % 5% 50 0% 0 Ashford C&C DG&S Medway SKC Swale Thanet W Kent E Surrey G&W NWSurrey S Downs S Heath NE Hants & Farnham B&H CWSussex Crawley EH&S H&R HWLH H&MS Kent Surrey Sussex

8 Ischaemic Stroke Activity - Percentage with Atrial Fibrillation (actual number with AF as diamond on right-hand axis) Data for calendar year 2013 Source: Secondary Uses Service (SUS Beddays 60% 50% Beddays KSS Beddays with AF % % % % % 0 Ashford C&C DG&S Medway SKC Swale Thanet W Kent E Surrey G&W NWSurrey S Downs S Heath NE Hants & Farnham B&H CWSussex Crawley EH&S H&R HWLH H&MS Kent Surrey Sussex

9 Ischaemic Stroke Activity - Percentage with Atrial Fibrillation (actual number with AF as diamond on right-hand axis) Data for calendar year 2013 Source: Secondary Uses Service (SUS 30-Day Readmissions 60% Readmissions KSS Readmissions with AF 30 50% 25 40% 20 30% 15 20% 10 10% 5 0% 0 Ashford C&C DG&S Medway SKC Swale Thanet W Kent E Surrey G&W NWSurrey S Downs S Heath NE Hants & Farnham B&H CWSussex Crawley EH&S H&R HWLH H&MS Kent Surrey Sussex

10 Ischaemic Stroke Activity - Percentage with Atrial Fibrillation (actual number with AF as diamond on right-hand axis) Data for calendar year 2013 Source: Secondary Uses Service (SUS Deaths 80% 70% 60% Deaths KSS Deaths with AF % 40 40% 30 30% 20% 20 10% 10 0% 0 Ashford C&C DG&S Medway SKC Swale Thanet W Kent E Surrey G&W NWSurrey S Downs S Heath NE Hants & Farnham B&H CWSussex Crawley EH&S H&R HWLH H&MS Kent Surrey Sussex

11 Ischaemic Stroke Activity - Percentage with Atrial Fibrillation (actual number with AF as diamond on right-hand axis) Data for calendar year 2013 Source: Secondary Uses Service (SUS Tariff 60% Tariff KSS Tariff with AF % % % % % % 0 Ashford C&C DG&S Medway SKC Swale Thanet W Kent E Surrey G&W NWSurrey S Downs S Heath NE Hants & Farnham B&H CWSussex Crawley EH&S H&R HWLH H&MS Kent Surrey Sussex

12 KENT, SURREY & SUSSEX Percentage of people on practice list on atrial fibrillation register 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Ashford Canterbury & Coastal Dartford, Gravesham & Swanley Source: QOF 2012/13 Medway South Kent Coast Swale Thanet West Kent East Surrey Guildford & Waverley North West Surrey Surrey Downs Surrey Heath NE Hants & Farnham Brighton & Hove Coastal West Sussex Crawley Practice KSS England KENT SURREY SUSSEX Eastbourne, Hailsham & Seaford Hastings & Rother High Weald Lewes Havens

13 90 Admissions to hospital for Stroke with Atrial Fibrillation as rate per 1000 Atrial Fibrillation practice register Source: Admissions from SUS, AF register from QOF 80 CCG KSS Ashford Canterbury & Coastal Dartford & Gravesham Medway S Kent Coast Swale Thanet W Kent East Surrey Guildford & Waverley NW Surrey Surrey Downs Surrey Heath NH Hants & Farnham Brighton & Hove Coastal West Sussex Crawley Eastbourne, Hailsham, Seaford Hastings & Rother High Weald Lewes Haven Horsham & Mid Sussex Kent Surrey Sussex

14 Time Series of AF Data 2006/07 to Quarter /2014 all SEC AF Stroke admissions Average of 24.1 % in Quarter 1 06/07, Average 31.2% in Quarter 3 13/14 AF Bed days Average of 29.2% in Quarter 1 06/07, Average of 36.6% in Quarter 3 13/14 AF Readmissions Average of 35.4% in Quarter 1 06/07, Average of 33.8% in Quarter 3 13/14 AF Deaths during admission Average of 40% in Quarter 1 06/07, Average of 54.4 % in Quarter 3 13/14 Overall percentage of stroke admissions with AF as comorbidity has increased since 06/07.? Reflects stroke prevention strategies have not impacted to the same degree on AF Stroke Burden of AF Stroke compared to other Stroke has increased since 06/07. Particularly for deaths during admission? A reflection that the advances in care since the National Stroke Strategy was published in 2008 have not had the same beneficial impact on AF Stroke

15 Summary Charts County CCG Stroke Admissions with Atrial Fibrillation ( 2013) Admissions Beddays 30-day readmissions Deaths PbR Tariff No. % No. % No. % No. % No. % Kent Ashford % % % % 200, % Canterbury & Coastal % % % % 386, % Dartford & Gravesham % % % % 271, % Medway % % % % 289, % S Kent Coast % % % % 506, % Swale % % % % 111, % Thanet % % % % 251, % W Kent % % % % 649, % Surrey East Surrey % % % % 240, % Guildford & Waverley % % % % 386, % NW Surrey % % % % 479, % Surrey Downs % % % % 278, % Surrey Heath % % % 0 0.0% 80, % NH Hants & Farnham % % % % 1,128, % Sussex Brighton & Hove % % % % 270, % Coastal West Sussex % % % % 1,085, % Crawley % % % % 172, % Eastbourne, Hailsham, Seaford % % % % 443, % Hastings & Rother % % % % 337, % High Weald Lewes Haven % % % % 243, % Horsham & Mid Sussex % % % % 383, % Kent, Surrey & Sussex % % % % 8,199, %

16 Ashford CCG: Atrial fibrillation at a glance