GP Dr Gavin Jamie looks at how practices can attain maximum points within the atrial fibrillation area of QOF’s clinical domain
Summary – indicators and value
- Indicators: 3
- Points: 29
- Prevalence: 2.1% (this is an estimate based on latest available QOF data and current trends)
- Estimated value per patient on the register: £30
Indicator AF001 – Maintain patient register (5 points)
There are five points for maintaining the register, which is fairly generous. In the decade or so that AF has been included in QOF, the prevalence has increased by 50%, and that rate continues to increase as practices improve the detection and recording of AF.
Patients are on the register simply if they have a diagnostic code for atrial fibrillation or flutter.
Have a system to investigate any newly irregular pulse.
The diagnosis should be confirmed with an ECG. All clinicians undertaking these examinations should know what to do when they detect an irregular pulse.
You should also search records for those on anticoagulation who don’t have a diagnosis of AF.
Indicator AF006 – Stroke risk assessment (12 points)
The risk of stroke is calculated using the CHA2DS2-VASc score. Once a patient has a score of 2 or more they are regarded as being at high risk. Low-risk patients, scoring less than 2, should be checked every year, and the results recorded.
If the patient scores 2 or above, no more recorded scores are required. An old CHADS score of 2 or more can also count.
The score is usually calculated by the computer based on the patient’s electronic record. An appropriate calculator can be used by a non-clinical member of staff.
Exception reporting (now known as personalised care adjustment) is available, but these are only general exceptions where patients are not suitable or do not agree to the assessment. In practice, it will be rare that a patient objects to a simple assessment.
As usual, patients who have registered with the practice or have been diagnosed between January and March are eligible for PCA. There are 12 points available for reaching 90% of patients, although average achievement is much higher.
Indicator AF008 – Anticoagulation medication (12 points)
There are a further 12 points for patients with a CHA2DS2-VASc score of 2 or more receiving anticoagulation with a DOAC prescription. If a patient is using warfarin or another vitamin K antagonist then there should be a code entered indicating an adverse reaction or contraindication to a DOAC.
If patients are unsuitable for oral anticoagulation in general then this should be coded. An adverse reaction to a DOAC is not sufficient to exclude them from the whole indicator.
Points for this indicator are awarded for achievement between 70% and 95%. These are high thresholds and represent a significant jump from previous versions of this indicator. Coding patients who are unsuitable or decline anticoagulation annually will be vital maximising achievement in this indicator.
Dr Gavin Jamie is a GP in Swindon and runs the QOF database website
NHS England – Quality and Outcomes Framework guidance for 2023/24. Published 30 March 2023.