Imperial College London
Alternate

Emeritus ProfessorDerekBell

Faculty of Medicine, School of Public Health

Emeritus Professor in Acute Medicine
 
 
 
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Contact

 

+44 (0)7886 725 212d.bell

 
 
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Assistant

 

Miss Heather Barnes +44 (0)20 3315 8144

 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Adeleke:2019:10.1136/openhrt-2019-001086,
author = {Adeleke, Y and Matthew, D and Porter, B and Woodcock, T and Yap, J and Hashmy, S and Mathew, A and Grant, R and Kaba, A and Unger-Graeber, B and Khan, S and Bell, D and Cowie, MR},
doi = {10.1136/openhrt-2019-001086},
journal = {Open Heart},
title = {Improving the quality of care for patients with or at risk of atrial fibrillation: an improvement initiative in UK general practices},
url = {http://dx.doi.org/10.1136/openhrt-2019-001086},
volume = {6},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective Atrial fibrillation (AF) is a growing problem internationally and a recognised cause of cardiovascular morbidity and mortality. The London borough of Hounslow has a lower than expected prevalence of AF, suggesting poor detection and associated undertreatment. To improve AF diagnosis and management, a quality improvement (QI) initiative was set up in 48 general practices in Hounslow. We aimed to study whether there was evidence of a change in AF diagnosis and management in Hounslow following implementation of interventions in this QI initiative.Methods Using the general practice information system (SystmOne), data were retrospectively collected for 415 626 patients, who were actively registered at a Hounslow practice between 1 January 2011 and 31 August 2018. Process, outcome and balancing measures were analysed using statistical process control and interrupted time series regression methods. The baseline period was from 1 January 2011 to 30 September 2014 and the intervention period was from 1 October 2014 to 31 August 2018.Results When comparing the baseline to the intervention period, (1) the rate of new AF diagnoses increased by 27% (relative risk 1.27; 95% CI 1.05 to 1.52; p<0.01); (2) ECG tests done for patients aged 60 and above increased; (3) CHA2DS2-VASc and HAS-BLED risk assessments within 30 days of AF diagnosis increased from 1.7% to 19% and 0.2% to 8.1%, respectively; (4) among those at higher risk of stroke, anticoagulation prescription within 30 days of AF diagnosis increased from 31% to 63% while prescription of antiplatelet monotherapy within the same time period decreased from 17% to 7.1%; and (5) average CHA2DS2-VASc and HAS-BLED risk scores did not change.Conclusion Implementation of interventions in the Hounslow QI initiative coincided with improved AF diagnosis and management. Areas with perceived underdetection of AF should consider similar interventions and methodology.
AU  - Adeleke,Y
AU  - Matthew,D
AU  - Porter,B
AU  - Woodcock,T
AU  - Yap,J
AU  - Hashmy,S
AU  - Mathew,A
AU  - Grant,R
AU  - Kaba,A
AU  - Unger-Graeber,B
AU  - Khan,S
AU  - Bell,D
AU  - Cowie,MR
DO  - 10.1136/openhrt-2019-001086
PY  - 2019///
SN  - 2053-3624
TI  - Improving the quality of care for patients with or at risk of atrial fibrillation: an improvement initiative in UK general practices
T2  - Open Heart
UR  - http://dx.doi.org/10.1136/openhrt-2019-001086
UR  - http://hdl.handle.net/10044/1/74071
VL  - 6
ER  -
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