Quality statement 3: Discussing options for anticoagulation

Quality statement

Adults with atrial fibrillation who are prescribed anticoagulation discuss the options with their healthcare professional at least once a year.

Rationale

Adults with non‑valvular atrial fibrillation should have the opportunity to discuss the choice of suitable anticoagulants with their healthcare professional, in order to improve adherence to treatment. Available options should include vitamin K antagonists (such as warfarin) and non‑vitamin K antagonist oral anticoagulants (NOACS; that is, apixaban, dabigatran etexilate, edoxaban and rivaroxaban). In adults with valvular atrial fibrillation, only vitamin K antagonists can be used, and this should be explained to the person. Adherence to anticoagulation can help to prevent stroke by reducing the likelihood of a blood clot forming.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with atrial fibrillation who are prescribed anticoagulation can discuss the options with their healthcare professional at least once a year.

Process

Proportion of adults with atrial fibrillation who are prescribed anticoagulation who discuss the options with their healthcare professional at least once a year.

Numerator – the number in the denominator who discuss the options with their healthcare professional at least once a year.

Denominator – the number of adults with atrial fibrillation who are prescribed anticoagulation.

Data source: Local data collection.

Outcome

a) Patient experience.

Data source: Local data collection.

b) Rates of adherence to anticoagulation therapy for adults with atrial fibrillation.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary and secondary care services) have protocols in place to ensure that adults with atrial fibrillation who are prescribed anticoagulation can discuss the options with their healthcare professional at least once a year.

Healthcare professionals discuss the options at least once a year with adults with atrial fibrillation who are prescribed anticoagulation. There should not be mandatory use of vitamin K antagonists before offering non‑vitamin K antagonist oral anticoagulants for people with non‑valvular atrial fibrillation.

Commissioners (NHS England area teams and clinical commissioning groups) specify that primary and secondary care service providers have protocols in place to ensure that adults with atrial fibrillation who are prescribed anticoagulation can discuss the options with their healthcare professional at least once a year.

What the quality statement means for patients, service users and carers

Adults with atrial fibrillation who are prescribed an anticoagulant have the chance to talk with their doctor at least once a year about the types of anticoagulant they could have and the advantages and disadvantages of each.

Source guidance

Atrial fibrillation (2014) NICE guideline CG180, recommendations 1.5.4, 1.5.6, 1.5.8 and 1.5.10

Definitions of terms used in this quality statement

Anticoagulants

Anticoagulants for people with atrial fibrillation include vitamin K antagonists (such as warfarin) and non‑vitamin K antagonist oral anticoagulants (NOACS; that is, apixaban, dabigatran etexilate, edoxaban and rivaroxaban).

[Adapted from Atrial fibrillation (NICE guideline CG180) and Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (NICE technology appraisal guidance 355)]

Discuss

Any discussion with an adult with atrial fibrillation should involve both oral and written information. A patient decision aid, such as that accompanying NICE's guideline on atrial fibrillation, can be used to inform the discussion. A discussion should take place at least once a year to review the need and quality of anticoagulation.

[Adapted from Atrial fibrillation (NICE guideline CG180), recommendation 1.5.18, Patient experience in adult NHS services (NICE guideline CG138), recommendation 1.5.12, and expert consensus]

Equality and diversity considerations

Discussions with adults with atrial fibrillation about choice of anticoagulants should take into account any additional needs, such as physical, sensory or learning disabilities, and people who do not speak or read English. People should have access to an interpreter or advocate if needed.