NICE recommends self-monitoring for people with atrial fibrillation and people with heart valve disease

[healthygirl]

24th September 2014:

The National Institute for Health and Care Excellence has recommended

self-monitoring for people with atrial fibrillation and people with heart valve disease.

They have made the recommendations for two monitors.

The CoaguChek XS system is recommended for self-monitoring

coagulation status in adults and children on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve disease if:

The person prefers this form of testing and the person or their carer is

both physically and cognitively able to self-monitor effectively.

The InRatio2 PT/INR monitor is recommended for self-monitoring coagulation status in adults and children on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve disease if:

The person prefers this form of testing and the person or their carer is

both physically and cognitively able to self-monitor effectively.

Although there is greater uncertainty of clinical benefit for the InRatio2 PT/INR monitor than for the CoaguChek XS system, the evidence indicates that the precision and accuracy of both monitors are comparable to laboratory-based INR testing.

Patients and carers should be trained in the effective use of the CoaguChek XS system or the INRatio2 PT/INR monitor and clinicians involved in their care should regularly review their ability to self-monitor. Equipment for self-monitoring should be regularly checked using reliable quality control procedures, and by testing patients’ equipment against a healthcare professional’s coagulometer which is checked in line with an external quality assurance scheme. Ensure accurate patient records are kept and shared appropriately. For people who may have difficulty with or who are unable to self-monitor, such as children or people with disabilities, their carers should be considered to help with self-monitoring.

The NICE guidance comes only a week after the Government published it response to a House of Commons Health Select Committee report into the management of long-term conditions, stressing the importance of self-management and noting that better use of technology in the NHS can empower patients, improve communication between services and deliver efficiencies and savings for the NHS.

Unfortunately, not everyone on long-term warfarin is expected to get access to the devices. The AntiCoagulation Self Monitoring Alliance (ACSMA) recently produced a report which revealed that two-thirds of Clinical Commissioning Groups (CCG) in England do not allow or support INR self-monitoring in their area. This means that the vast majority of people on long-term warfarin are being denied the opportunity to self-monitor, despite the benefits to the patient in terms of health outcomes, convenience and quality of life, and the long-term cost savings to the health service.

Let’s hope CCGs look at the guidance closely and incorporate its recommendations into their anticoagulation service at the earliest opportunity, so that the benefits of self-monitoring can be offered to as many people as possible.

The full NICE guidance is at: nice.org.uk/guidance/dg14

[dedeottie]

My goodness. This is a real milestone. Forgive my ignorance but what does this mean in practice? Does it mean that if a patient requests self testing then you can have it regardless of the seeming postcode lottery?

[Kempsh0tt]

Yes, even at a summary level, the document is 'hard-work' and as for the full NICE guidance, large chunks are sadly unfathomable.

My basic understanding is that with NICE recommending 'self monitoring', local health-care commissioning groups (CCGs) will have to make a decision as to whether they will support the NICE recommendations. There are financial implications (the cost of the equipment) - even though longer term, costs reduce/outcomes for patients improve.

So it will most likely hinge on whether a local CCG can find the money (tough in the current austerity-measure times) or will be willing to apply an amount from a future budget. That assumes they agree to follow the NICE guidelines - not compulsory!.

I don't expect much in the short-term let's put it that way, but some coordinated lobbying might not go amiss. Others who have more insight may wish to correct or comment. TC

[ianp5uk]

Well that's good but why only 2 specific conditions?

I self monitor much to my GP's displeasure. I had 2 PE's for uncertain reasons. Probably first one due to a DVT from a period of immobility (16 hours desk bound working), the second because of the first.