Since 2014 the 15 Academic Health Science Networks (AHSNs) across England have been working on a collaborative atrial fibrillation (AF) programme focused on reducing AF-related stroke. The national programme has three elements: Detect: finding more people with AF to allow early intervention to prevent stroke; Protect: treating more at-risk patients with anticoagulants to reduce the rate of AF-related stroke; and Perfect: improving the quality of anticoagulation to ensure maximal patient outcomes.
The second update of the original European Heart Rhythm Association (EHRA) practical guide on the use of the new oral anticoagulants (NOACs) in patients with atrial fibrillation provides primary care a useful document to use in every day practice. Nigel Rowell, a member of the ESC Scientific Document Group that drafted the latest guide, provides some background on the development of the latest update.
Swallowing really is a life or death matter. Nearly half of people who have had a stroke will initially experience difficulty swallowing. This is called dysphagia. In this article, we look at the anatomy and physiology of swallowing, what can go wrong in people who have had a stroke, and what can help. Explanations are given clearly, using simple language that you can use with patients and their family members.
A new case study shows the significant reduction in atrial fibrillation-related stroke incidence achieved using the GRASP-AF audit tool. The case study, highlights improvements in key measures including a 4% reduction in the number of patients treated inappropriately, a 5% increase in the use of oral anticoagulation therapy and a 10% reduction in AF-related strokes.
Following a stroke up to 60% of people have sight problems, including loss of visual field and trouble with visual processing when the brain no longer makes sense of what the eye sees. Changes to vision can also be a sign of stroke or transient ischaemic attack (TIA). The awareness of visual problems in stroke patients is highlighted in this article which explains the different sight problems and outlines steps which can be taken to help.
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A European survey shows that atrial fibrillation (AF) patients with lower standards of education benefit least from oral anticoagulation. The study raises the need for more user-friendly educational tools for AF patients.
Over my lifetime, treatment for heart disease has improved beyond recognition. For the last six years, I have had the privilege of leading a programme that has accelerated that change, reducing waiting times, bringing in new treatments, training more specialists, and ensuring patients have more and better choices available. I am now working to repeat those strides forward for stroke, the brain's equivalent of heart attack. There are a similar number of strokes to heart attacks, but this equally devastating condition has been slower to catch the medical and public imagination in this country. With our ageing population, it represents a growing challenge for the future.
"There are lots of really powerful examples around o f things we can do to improve quality while improving productivity"
This statement from Sir David Nicholson, the NHS Chief Executive, appears on the NHS Evidence website, where the recognition and optimal treatment of atrial fibrillation (AF) is given as one of the top six Quality, Innovation, Productivity and Prevention (QIPP) examples from across the entire NHS.