Quality statement 5: Referral for specialised management

Quality statement

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

Rationale

Prompt referral of adults with atrial fibrillation to specialised management if treatment fails can help to alleviate symptoms and reduce the likelihood of poor outcomes such as stroke and heart failure.

Quality measures

Structure

Evidence of local arrangements and referral pathways to ensure that adults with atrial fibrillation whose treatment fails to control their symptoms are referred for specialised management within 4 weeks.

Data source: Local data collection.

Process

Proportion of adults with atrial fibrillation whose treatment fails to control their symptoms who are referred for specialised management within 4 weeks.

Numerator – the number in the denominator who are referred for specialised management within 4 weeks.

Denominator – the number of adults with atrial fibrillation whose treatment fails to control their symptoms.

Data source: Local data collection.

Outcome

a) Adults with atrial fibrillation symptom control.

Data source: Local data collection.

b) Rates of stroke and heart failure 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 procedures in place to ensure that adults with atrial fibrillation whose treatment fails to control their symptoms are referred for specialised management within 4 weeks.

Healthcare professionals refer adults with atrial fibrillation whose treatment fails to control their symptoms, to specialised management within 4 weeks.

Commissioners (NHS England area teams and clinical commissioning groups) ensure that primary and secondary care providers have procedures in place so that adults with atrial fibrillation whose treatment fails to control their symptoms are referred for specialised management within 4 weeks.

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

Adults with atrial fibrillation who still have symptoms after treatment are referred within 4 weeks for specialised care that aims to ease their symptoms and reduce their risk of having a stroke or heart failure.

Source guidance

Atrial fibrillation (2014) NICE guideline CG180, recommendation 1.3.1 (key priority for implementation)

Definitions of terms used in this quality statement

Fails to control symptoms

Adults whose treatment fails to control the symptoms of atrial fibrillation at any stage.

[Adapted from Atrial fibrillation (NICE guideline CG180), recommendation 1.3.1]

Referred within 4 weeks

Referral should be no longer than 4 weeks after the final failed treatment or no longer than 4 weeks after recurrence of atrial fibrillation after cardioversion.

[Adapted from Atrial fibrillation (NICE guideline CG180), recommendation 1.3.1]

Specialised management

Specialised management can be provided by an 'atrial fibrillation specialist' such as a cardiologist or nurse with an interest in arrhythmia. 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.

[Atrial fibrillation (NICE guideline CG180), full guideline]