Quality standard
Quality statement 5: Referral for specialised management
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.
What the quality statement means for different audiences
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.
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: diagnosis and management. NICE guideline 196 (2021), recommendation 1.5.1
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 NICE's guideline on atrial fibrillation, recommendation 1.5.1]
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 NICE's guideline on atrial fibrillation, recommendation 1.5.1]
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. [NICE's 2014 full guideline on atrial fibrillation]