Preventing strokes in people with atrial fibrillation by improving ABC Article Swipe
Jagjot Kaur Chahal
,
Sotiris Antoniou
,
Mark J. Earley
,
Shabana Ali
,
Khalid Saja
,
Harjit Singh
,
Peter K. MacCallum
,
John Robson
·
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1136/bmjoq-2019-000783
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1136/bmjoq-2019-000783
Nationally, anticoagulation for atrial fibrillation (AF) is improving but remains characterised by marked provider variation. Uncontrolled blood pressure and coronary artery disease further increase cardiovascular risk. Redbridge Clinical Commissioning Group (CCG) and local National Health Service (NHS) hospital trusts supported a programme to improve anticoagulation, blood pressure and cholesterol management; the ABC of AF improvement. The programme was delivered by a clinical pharmacist in 43 general practices, who used Active Patient Link (APL-AF) software to identify and electronically review the records of AF patients potentially suitable for anticoagulation. These patients were invited for a general practitioner (GP)-pharmacist consultation with initiation of anticoagulation where appropriate. Blood pressure and lipid treatment were also optimised. The university-based Clinical Effectiveness Group (CEG) provided software support using standard data entry templates from which the APL-AF software was enabled. This identified suitable patients (eg, on aspirin monotherapy, no treatment or inappropriate dual treatments) for clinical and treatment review. It also reported real-time overall practice performance. Additionally, GP education on direct oral anticoagulant initiation in general practices, use of software and performance reviews, took place for all practices in Redbridge. A weekly multidisciplinary team (MDT) video conference discussed complex patients with a cardiologist, haematologist, GP with specialist interest in cardiology, GP coordinator and clinical pharmacist. This enabled sharing of patient records between GPs and hospital specialists with improved communication and learning. Over 1 year 2016–2017, anticoagulation in eligible AF patients (CHA 2 DS 2 -VASc≥2) increased significantly by 6.3% from 77.0% to 83.3% (p<0.0001), in comparison to 2.8% average improvement in England. Exception reporting was also significantly reduced from 10.0% to 5.8%; a reduction of 4.2% in comparison to a reduction in England of 1.5%. Use of antiplatelet monotherapy was approximately halved, from 12.3% to 6.4%. These methods are being scaled locally in other London CCGs and are potentially scalable nationally, specifically targeting the poorer performing CCGs.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1136/bmjoq-2019-000783
- https://bmjopenquality.bmj.com/content/bmjqir/8/4/e000783.full.pdf
- OA Status
- gold
- Cited By
- 15
- References
- 2
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2990678077
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W2990678077Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1136/bmjoq-2019-000783Digital Object Identifier
- Title
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Preventing strokes in people with atrial fibrillation by improving ABCWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2019Year of publication
- Publication date
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2019-11-01Full publication date if available
- Authors
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Jagjot Kaur Chahal, Sotiris Antoniou, Mark J. Earley, Shabana Ali, Khalid Saja, Harjit Singh, Peter K. MacCallum, John RobsonList of authors in order
- Landing page
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https://doi.org/10.1136/bmjoq-2019-000783Publisher landing page
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https://bmjopenquality.bmj.com/content/bmjqir/8/4/e000783.full.pdfDirect link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://bmjopenquality.bmj.com/content/bmjqir/8/4/e000783.full.pdfDirect OA link when available
- Concepts
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Medicine, Atrial fibrillation, Pharmacist, Clinical pharmacy, Blood pressure, Coronary artery disease, Internal medicine, Aspirin, Medical emergency, Emergency medicine, Pharmacy, Family medicineTop concepts (fields/topics) attached by OpenAlex
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15Total citation count in OpenAlex
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2025: 3, 2024: 1, 2023: 4, 2022: 3, 2021: 4Per-year citation counts (last 5 years)
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2Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.scalable | 302 |
| abstract_inverted_index.software | 73, 119, 130, 172 |
| abstract_inverted_index.standard | 122 |
| abstract_inverted_index.suitable | 85, 135 |
| abstract_inverted_index.Exception | 255 |
| abstract_inverted_index.Redbridge | 26 |
| abstract_inverted_index.delivered | 58 |
| abstract_inverted_index.discussed | 190 |
| abstract_inverted_index.education | 161 |
| abstract_inverted_index.improving | 7 |
| abstract_inverted_index.increased | 238 |
| abstract_inverted_index.learning. | 223 |
| abstract_inverted_index.practices | 180 |
| abstract_inverted_index.programme | 41, 56 |
| abstract_inverted_index.real-time | 155 |
| abstract_inverted_index.reduction | 266, 273 |
| abstract_inverted_index.reporting | 256 |
| abstract_inverted_index.supported | 39 |
| abstract_inverted_index.targeting | 305 |
| abstract_inverted_index.templates | 125 |
| abstract_inverted_index.treatment | 108, 142, 150 |
| abstract_inverted_index.-VASc≥2) | 237 |
| abstract_inverted_index.Redbridge. | 182 |
| abstract_inverted_index.comparison | 248, 270 |
| abstract_inverted_index.conference | 189 |
| abstract_inverted_index.identified | 134 |
| abstract_inverted_index.initiation | 99, 166 |
| abstract_inverted_index.optimised. | 111 |
| abstract_inverted_index.performing | 308 |
| abstract_inverted_index.pharmacist | 62 |
| abstract_inverted_index.practices, | 66, 169 |
| abstract_inverted_index.specialist | 199 |
| abstract_inverted_index.variation. | 14 |
| abstract_inverted_index.Nationally, | 0 |
| abstract_inverted_index.cardiology, | 202 |
| abstract_inverted_index.cholesterol | 48 |
| abstract_inverted_index.coordinator | 204 |
| abstract_inverted_index.improvement | 252 |
| abstract_inverted_index.management; | 49 |
| abstract_inverted_index.monotherapy | 281 |
| abstract_inverted_index.nationally, | 303 |
| abstract_inverted_index.performance | 174 |
| abstract_inverted_index.pharmacist. | 207 |
| abstract_inverted_index.potentially | 84, 301 |
| abstract_inverted_index.specialists | 218 |
| abstract_inverted_index.treatments) | 146 |
| abstract_inverted_index.2016–2017, | 227 |
| abstract_inverted_index.Uncontrolled | 15 |
| abstract_inverted_index.antiplatelet | 280 |
| abstract_inverted_index.appropriate. | 103 |
| abstract_inverted_index.consultation | 97 |
| abstract_inverted_index.fibrillation | 4 |
| abstract_inverted_index.improvement. | 54 |
| abstract_inverted_index.monotherapy, | 140 |
| abstract_inverted_index.performance. | 158 |
| abstract_inverted_index.practitioner | 95 |
| abstract_inverted_index.specifically | 304 |
| abstract_inverted_index.Additionally, | 159 |
| abstract_inverted_index.Commissioning | 28 |
| abstract_inverted_index.Effectiveness | 115 |
| abstract_inverted_index.anticoagulant | 165 |
| abstract_inverted_index.approximately | 283 |
| abstract_inverted_index.cardiologist, | 195 |
| abstract_inverted_index.characterised | 10 |
| abstract_inverted_index.communication | 221 |
| abstract_inverted_index.inappropriate | 144 |
| abstract_inverted_index.significantly | 239, 259 |
| abstract_inverted_index.(p<0.0001), | 246 |
| abstract_inverted_index.cardiovascular | 24 |
| abstract_inverted_index.electronically | 77 |
| abstract_inverted_index.haematologist, | 196 |
| abstract_inverted_index.(GP)-pharmacist | 96 |
| abstract_inverted_index.anticoagulation | 1, 101, 228 |
| abstract_inverted_index.anticoagulation, | 44 |
| abstract_inverted_index.anticoagulation. | 87 |
| abstract_inverted_index.university-based | 113 |
| abstract_inverted_index.multidisciplinary | 185 |
| cited_by_percentile_year.max | 97 |
| cited_by_percentile_year.min | 90 |
| corresponding_author_ids | https://openalex.org/A5062674558 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 8 |
| corresponding_institution_ids | https://openalex.org/I225661044 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.4300000071525574 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.80878629 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |