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What the new NHS National medicines optimisation opportunities means for atrial fibrillation



Atrial fibrillation is a ‘silent condition’ that is a leading cause of stroke, yet can often go undiagnosed. The new NHS National medicines optimisation opportunities for 2023/24 gives details on implementing the best value treatment choices.

Earlier this year the Stroke Association conducted a survey to examine the awareness of atrial fibrillation in the UK, the survey revealed that 73 per cent of its respondents did not know that atrial fibrillation was a direct cause of major stroke.

According to data released at the time alongside the Stroke Association’s survey, one in five strokes are directly related to atrial fibrillation, which is an estimated 40 strokes per day. These strokes are also likely to be more severe and more likely to result in death or serious disability.

Juliet Bouverie OBE, chief executive of the Stroke Association, commented: “It’s worrying that so few people know that a little thing like how your heart beats can lead to a massive stroke.”

Further details from the survey revealed that:

  • Six in ten (62 per cent) said they had never checked themselves for AF
  • Almost half (44 per cent) said they had never been checked for AF by a healthcare professional
  • More than eight in ten (83 per cent) said they would be likely to seek medical advice if they felt something was wrong with the rhythm of their heartbeat/pulse
  • 55 per cent said they knew someone who had had a stroke
  • 26 per cent knew someone who had had AF 

In the new NHS National medicines optimisation opportunities it is stated that an estimated 1.5 million individuals in the UK are currently living with atrial fibrillation. Those living with atrial fibrillation tend to be older or living with long-term (chronic) conditions such as heart disease, high blood pressure or obesity.

An estimated further 400,000–600,000 individuals will have atrial fibrillation, however, are yet to be identified.

NHS England’s Commissioning recommendations for the national procurement of direct acting oral anticoagulants (DOACs) has outlined the best value treatment choices, in order to maximise affordability and support treatment for the greatest number of patients.

With increased diagnosis of AF, the recommendations aim to:

  • improve availability of direct-acting anticoagulants (DOACs)
  • support uptake of DOAC medicines.

Currently four DOACs are licensed to treat atrial fibrillation in the UK.

The detect, protect and perfect (DPP) objectives of the national initiative to expand the use of DOACs for the treatment of atrial fibrillation are:

  1. Detect – reduce incidence of stroke by diagnosing more patients with AF.
  2. Protect – ensure patients diagnosed with AF are offered anticoagulation, where appropriate.
  3. Perfect – ensure patients with AF are on the correct dose of the best value DOAC (edoxaban), where clinically appropriate. If edoxaban is not clinically appropriate, consider rivaroxaban, and then apixaban or dabigatran.

This implementation is hoped to reduce the number of people experiencing atrial fibrillation-related deaths and strokes by around 5,400 and 21,700, respectively, over the next 3 years.