Latest standards guidance on AF and Anti-coagulation choices for patients

[rosyG]

Hi All,

This link nice.org.uk/guidance/qs93/c... was sent to me today by the South East Coast network as I was involved as a patient rep with some work they did on AF.

It is good to know what the new standards of care are and, in particular, see the anti-coagulation section where it says clinicians should NOT insist Warfarin has to be tried first. These standards were published in July so good to quote when having appointments. Also contains details on referrals etc,

\Hope all are well- looking forward to Ian's Natter and Nosh!

Best wishes,

Rosemary

[Rellim296]

Thanks for this, Rosy. Interesting. I like the word coagulometer!

I'm sorry I can't get down on the 29th.

[Peddling]

Thanks Rosy, very helpful link. Thank you too for your response to my earlier query re changeover. We have seen GP who was more clued up than I thought. He did puzzle me though by saying he thought flecanide shouldn't be taken by patients when in AF! Anyone else heard about this?

[BobD Volunteer]

Hi Rosy thanks for that.Two things which jumped out for me are 1) that people on warfarin with poor INR control be offered NOACs and 2) people on long term warfarin be supported to us coagucheck type machines. Note it doesn't say supplied with .lol Much of this I think is repeated from 2014 guidelines but good anyway. I wonder how long it will take GPs to get the message.

Bob.

[rosyG]

Yes you're right Bob- it builds on the guidelines but good to have standards so we can quote to clinicians when we need to!!

I agree re self testing. I wonder if they might find it when more people are on NOACs as INR clinics won't get economies of scale. May take a long time though !!

[BobD Volunteer in reply to rosyG]

Interesting thing today. Went for my INR test and mentioned the new guidelines to the nurse who agreed that they had already seen them and it had been flagged up throughout the practise. We discussed the question of Coagucheck support and she knocked me down with a feather by telling me that they were discussing maybe providing machines to some SELECTED patients . These may possibly be rented or leased and only to responsible people who they felt could manage their own dosing " like you " she said. "There are too many idiots out there I wouldn't trust " was her next comment.

Could this be the age of enlightenment?

2.7 by the way down from 2.9 six weeks ago. Max period between visits has now been reduced from twelve weeks to ten by the way.

Bob

[Hidden]

Thanks Rosemary, lots of useful information and covers many of the points raised at recent Surrey Downs CCG PAG!

John

[Hidden]

Hi Rosemary; that's a really useful link and I see that I'm not in line for anticoag until 75 now.

John

[Mrspat]

What it does seem to miss out is advice for people with a CHADS-VASC2 score of under 2 and/or other accompanying heart conditions. I score zero, unless you count the 1 for being female. GP was happy for me not to have anticoagulants because of the zero score but cardiologist insisted due to my congenital heart condition.

[Beancounter Volunteer]

For me the guideline which shouted out at me was No 5

"Adults with atrial fibrillation whose treatment fails to control their symptoms are referred for specialised management within 4 weeks."

More details here

nice.org.uk/guidance/qs93/c...

How many times have we heard on this forum about people with symptomatic AF not seeing being able to see a specialist for months let alone weeks.

I would carry a copy of this guideline into my GP and even my general Cardiologist if I was on a long waiting list for anything.

Word for word from the guidance....

"Specialised management should be provided through a package of care that covers key elements of service provision, tailored to the person with atrial fibrillation. Formally documenting key elements of the service can help to ensure that it has been delivered."

[rosyG]

that's funny Bob!

Self testing is not rocket science- if patients can be trusted to take the right dose of warfarin I think they can be trusted to self test!!