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Audit of atrial fibrillation management

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Audit date

1999 onwards

Method

Computer searches of patients with AF and an assessment of computer recording of associated data associated with the atrial fibrillation protocol.

Results

  Date TBL BCS JMW BNC ACB RMW Total Notes
No of patients with AF Sep-99 30 24 25 28 10 33 150 ACB has less patients with AF: this is a reflection of the lower numbers of elderly patients.
Jan-00 30 24 26 29 8 34 151
Dec-00 35 30 29 31 8 42 175
Jul-01 31 35 34 29 10 45 184 Increased awareness has resulted in an increase in numbers.
% of patients with AF Sep-99 20% 16% 17% 19% 7% 22% 100%  
Jan-00 20% 16% 17% 19% 5% 23% 100%
Dec-00 20% 17% 17% 18% 5% 24% 100%
Jul-01 17% 19% 19% 16% 5% 25% 100%
Patients on digoxin without read code for AF Sep-99 9 7 12 6 0 4 38 Some patients may  not have AF (eg digoxin for heart failure) but this search was used to check for accurate data.
Jan-00 4 10 12 4 1 4 35
Dec-00 4 7 7 3 0 3 24
Patients with AF without read code for ECG Sep-99 24 20 21 6 8 14 93 If ECG is performed in hospital there may not  be a surgery Read code.
Jan-00 22 20 21 6 6 12 87
Jul-01

21

25

21

7

6

15

95
% patients with AF with read code for ECG Sep-99 20% 17% 16% 79% 20% 58% 38% Electronic ECG's were implemented in mid-2000 and recording of ECG read codes before this time was ad hoc.
Jan-00 27% 17% 19% 79% 25% 65% 42%
Jul-01 32% 29% 38% 76% 40% 67% 48%
No of patients taking warfarin Sep-99   75  
Jan-00   76
Dec-00   89
Jul-01   93
% of patients taking warfarin Sep-99   50%  
Jan-00   50%
Dec-00   51%
Jul-01   51%
No of patients taking aspirin Dec-00  

76

  
Jul-01   80
% of patients taking aspirin Dec-00   43%  
Jul-01   44%
Patients with AF Read code but not on prophyllaxis or recorded c/i Sep-99 2 2 4 3 0 6 17 Improvements were made here to ensure that all patients were receiving prophyllaxis. The remaining patients are those in whom the AF has resolved and are in sinus rhythm (eg AF caused by thyrotoxicosis).
Jan-00 5 3 3 0 0 7 18
Dec-00 6 2 4 1 0 4 17
Jul-01 2? 1? 1+2? 0 1? 2+1? 3+7? data from computer record. ? = not clear from record.
% patients with AF on prophyllaxis or recorded c/i Sep-99 93% 92% 84% 89% 100% 82% 89% In some patients AF has resolved.
Jan-00 83% 88% 88% 100% 100% 79% 88%
Dec-00 83% 93% 86% 97% 100% 90% 90%
Jul-01 94% 97% 91% 100% 90% 93% 95% (? patients are considered not to be on prophyllaxis)
Patients with AF and no record of echocardiogram Sep-99 26 21 18 13 8 24 110 Echocardiography may not be specifically read coded if it has been performed in hospital.
Jan-00 27 20 18 12 6 24 107
Dec-00 29 22 18 14 6 28 117
Jul-01 25 20 20 14 7 24 110
% patients with AF with record of echocardiogram Sep-99 13% 13% 28% 54% 20% 27% 27%  
Jan-00 10% 17% 31% 59% 25% 29% 29%
Dec-00 17% 27% 38% 55% 25% 33% 33%
Jul-01 19% 43% 41% 52% 30% 47% 40%
Patients with AF and no record of CXR Sep-99 20 18 15 11 5 16 85 X-rays performed in hospital may not be recorded.
Jan-00 16 18 16 12 3 16 81
Dec-00 19 19 14 11 2 21 86
Jul-01

18

 22 15 10 4 20 89
% patients with AF with record of CXR Sep-99 33% 25% 40% 61% 50% 52% 43%  

 
Jan-00 47% 25% 38% 59% 63% 53% 46%
Dec-00 46% 37% 52% 65% 75% 50% 51%
Jul-01 42% 37% 56% 66% 60% 56% 52%
Patients with AF and no record of TSH Sep-99 11 9 9 6 3 6 44 TSH may not be recorded if initially measured in hospital.
Jan-00 11 8 7 7 0 8 41
Dec-00 9 11 6 8 1 8 43
Jul-01 8 10 6 8 2 5 39
% patients with AF with record of TSH Sep-99 63% 63% 64% 79% 70% 82% 71%  
Jan-00 63% 67% 73% 76% 100% 76% 73%
Dec-00 74% 63% 79% 74% 88% 81% 75%
Jul-01 74% 71% 82% 72% 80% 89% 79%

Comment

The process of this audit increased awareness of the management of AF. The care of every patient with AF was reviewed by their usual doctor and action taken when required. In January 2001 the notes of all patients with a Read code for AF who did not have prophylaxis were reviewed, and all patients were found to be on prophylaxis if appropriate (persistent AF and no contraindication). An AF Sophie was developed as a result of the first cycle of the audit to assist in the Read coding for these patients, but 100% accuracy of Read coding from hospital letters is difficult (and also requires the data to be present in the letter!).

Plan

Annual review of patients with AF.

Cycle 2003

 

Audit date

December2003

Method

Computer searches of patients with AF and an assessment of computer recording of associated data associated with the atrial fibrillation protocol.

Results

 

Total No Patients

Atrial Fibrillation

Warfarin

Aspirin

No Warfarin/Aspirin

Dec 2003

10567

218

85  ( 39% )

76  ( 34% )

59  ( 27% )

June 2001

 

191

77  ( 40% )

70  ( 36% )

49  ( 24% )

Dec2000

 

175

 

 

 

Sept 1999

 

150

 

 

 

 Comment

Prevention thromboembolism in AF

Warfarin reduces the risk of ischaemic stroke by 65%

Aspirin reduces the risk of ischaemic stroke by 20%

Plan

Logo Brad Cheek/Brent Smith: