Atrial fibrillation: pulse rhythm assessment in people at risk
Indicator
The percentage of patients registered at the practice aged 65 years and over who have been diagnosed with 1 or more of the following conditions: coronary heart disease, heart failure, hypertension, diabetes, CKD, PAD, or stroke/TIA who have had a pulse rhythm assessment in the preceding 12 months.
Indicator type
General practice indicator suitable for use in the Quality and Outcomes Framework.
This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators.
To find out how to use indicators and how we develop them, see our NICE indicator process guide.
Rationale
This indicator measures the proportion of patients with 1 or more of the listed conditions, aged 65 years and over, who have had an assessment of pulse rhythm on at least 1 occasion in the preceding 12 months. NICE guidance recommends that patients with these conditions should have their blood pressure recorded on an annual basis. Pulse rhythm should be assessed prior to taking an automated blood pressure as an irregular pulse can affect the accuracy of the blood pressure measurement. Patients with these conditions are also at increased risk of cardiac arrhythmias, including atrial fibrillation. Untreated atrial fibrillation represents a significant and potentially preventable stroke risk. Patients with an irregular pulse should be offered further investigations to identify the cause of any arrhythmia.
Source guidance
Acute coronary syndromes. NICE guideline NG185 (2020), recommendation 1.4.2.
Hypertension in adults: diagnosis and management. NICE guideline NG136 (2019), recommendations 1.1.2 and 1.2.11.
Chronic heart failure in adults: diagnosis and management. NICE guideline NG106 (2018), recommendation 1.7.1.
Type 1 diabetes in adults: diagnosis and management. NICE guideline NG17 (2015, updated 2021), recommendation 1.13.2
Chronic kidney disease. NICE guideline NG203 (2021), recommendation 1.6.1
Peripheral arterial disease: diagnosis and management. NICE guideline CG147 (2012, updated 2020), recommendation 1.2.1
Specification
Numerator: The number of patients in the denominator who have had a pulse rhythm assessment in the preceding 12 months.
Denominator: The number of patients aged 65 and over registered at a GP practice who have been diagnosed with one or more of the following conditions: coronary heart disease, heart failure, hypertension, diabetes, CKD, PAD, or stroke/TIA.
Calculation: Numerator divided by the denominator, multiplied by 100.
Exclusions: None.
Minimum population: The indicator would be appropriate to assess performance at individual general practice level.
ISBN: 978-1-4731-5920-4