Stroke prevention in atrial fibrillation (AF) – competitive grant scheme

The BMS-Pfizer Alliance has partnered with the AHSN Network to provide independent grant support to organisations for healthcare quality improvement and education projects through Pfizer’s Independent Grants for Learning & Change (IGLC) programme. The mission of Pfizer’s Office for IGLC is to partner with the global healthcare community to improve patient outcomes in areas of mutual interest through support of measurable learning and change strategies.
The project is providing grants to fund projects that aim to improve the identification and management of atrial fibrillation (to prevent stroke), with a focus on service evaluation, medical education and quality improvement projects.
The Request for Proposals (RFP) document describes the clinical practice areas that the project hopes to address with available grant funding. Successful applications should aim to meet such identified clinical gaps and must comply with clause 19 of the ABPI Code of Practice (Medical and Educational Goods and Services).
Submissions are welcomed from AHSNs across the country, including similar organisations within Scotland, Wales and Northern Ireland. The applications will be reviewed by an independent panel including experts within the field.
The deadline for applications is 3 August 2018 (midnight, UK GMT) and successful grant awardees will be notified by the end of September 2018.
Further information on the application and/or submission process can be found in the Request for Proposal document.
If you have questions regarding this, please direct them in writing to the Grant Officer, Jo Harbron with the subject line “UK-AF stroke reduction”.
This programme was run in 2016 and 2017 and the successful project summaries can be found below. It would be expected that projects submitted in 2018 would not overlap significantly or repeat those that were funded in previous years. Magnification/expansion of previously successful quality improvement programmes in these therapy areas would be considered within scope.

2016 IGLCs

Innovation Agency North West Coast
Lancashire has one of the highest rates of Atrial Fibrillation (AF) related strokes within the UK. One of the main contributing factors is the number of undetected AF patients and a poor rate of anti-coagulation control in those that have been identified with AF.
The goal of this project is to reduce and prevent strokes secondary to AF by optimising existing AF pathways and integrating innovative technologies, such as genotype-guided dosing and use of devices to support self-monitoring, which include digital integration to the GP or hospital systems from the patient via an App, automated phone call or web portal.
This project aims to match the right patient with the most suited anticoagulation therapy, empower patients, optimise staff time and allow easy data sharing and reduce the financial burden of strokes on the NHS.
Cambridge University Hospitals NHS Foundation Trust
Studies carried out from 2012 onwards showed that nearly half the patients admitted with AF were not anticoagulated. In response to this, the SOS-AF project was created focusing on stroke prevention by introducing a specialist service consisting of stroke consultants, registrars and specialists nurses. By supporting both primary and secondary care (inpatient and outpatient) services, the aim is to increase AF detection within the area, offer risk stratification and appropriate management of anticoagulation.
AHSN North East and North Cumbria (NENC)
There are over 3,000 people with undiagnosed Atrial Fibrillation (AF) in the Newcastle Gateshead CCG area, and a third of people who suffer a stroke are known to have AF, but are not taking any form of anticoagulation. This project aims to optimise the AF anticoagulation pathway in Newcastle with the introduction of three innovations: warfarin sensitivity genotype testing before choice of anticoagulant is made, then where appropriate, genotype guided warfarin initiation, and subsequently an option for patients to self-test their INR at home.
Oxford Academic Health Science Network
The provision of anticoagulation therapy is primarily managed within General Practice, where there are well-known demand and recruitment pressures. In order to reduce the burden, the project is introducing a novel model of anticoagulation where a Specialist Pharmacist works with the patient to decide on appropriate anticoagulation and prescribe the first month’s therapy. The model also provides consistency in prescribing, as the team of Specialist Pharmacists will be working to defined anticoagulation guidelines
Sandwell and West Birmingham Hospitals NHS Trust
Data from NHS England for the Black Country STP data pack showed that in 2016, premature death from stroke is worse than national average. The project aims to incorporate evidence-based education, improve the quality of AF diagnosis, treatment and management. These are done through up-skilling mainly primary care clinicians but also secondary care clinicians, use of mobile detection devices (AliveCor) and implementation of pathway changes. The project also utilises a multimedia information-sharing platform to provide Primary Care clinicians further support from specialists.

2017 IGLCs

AF Advance Programme East Midlands
Since April 2013, quality improvement projects carried out in the East Midlands has increased the number of patients diagnosed with AF and also improved the rate of high-risk AF patients being treated with anticoagulation. This project aims to further these improvements in Primary Care by utilising AliveCor Kardia mobile devices to increase AF detection rates, reduce number of undiagnosed AF patients and provide effective anticoagulation in newly diagnosed patients.
Wessex AHSN
“There are 10% more people aged over 65 year within the Dorset CCG than national average, this increases the likelihood of Atrial Fibrillation and therefore the risk of stroke. With the introduction of direct oral anticoagulants (DOACs), some in Primary Care may benefit from support when discussing choices of anticoagulation therapy with patients. The aim of the project is to empower Primary Care clinicians (including pharmacists) by improving their knowledge and skill. Therefore, lead to increased identification and review of AF patients, as well as be in the position to counsel them for the most suitable therapy.”
Imperial College NHS Trust
There is a median 3% per annum risk of stroke at the time of diagnosis of AF. This project recognise the importance of initiating anticoagulation at the earliest possible opportunity post diagnosis by establishing a community based system for identification, triaging and early risk management. Patients at risk of AF or those with symptoms suggestive of AF are given smart phones equipped with AliveCor devices. The results are fed back to a centralised team where the ECG findings are managed accordingly to predefined protocols. The aim is also for the centralised team to be the first point of contact for Primary Care clinicians and will provide necessary up-skilling of GPs.
Royal Brompton and Harefield NHS Foundation Trust
Community pharmacists currently provide advanced services such as Medicines Use Reviews and New Medicine Service. They therefore not only have the skills but are ideally situated to facilitate AF diagnosis and management.
In this project 30 community pharmacies in the Hillingdon area will aid AF detection by identifying patients aged over 65 years with AF associated risk factors and undertaking an ECG using the Kardia monitor. Anyone who is found to have undiagnosed AF and is not appropriately anticoagulated or those with diagnosed AF with a high symptom burden or problems with anticoagulation will be referred to the Arrhythmia Care Team at Harefield Hospital for prompt management.

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