24 November 2015

Helping people with AF make informed choices about their treatment

NICE has endorsed a new decision support tool that aims to help healthcare professionals and people with atrial fibrillation (AF) make informed decisions about the most appropriate treatments.

The online tool is in two parts and encourages partnership between patients and healthcare professionals when reaching a decision about the use of anticoagulants to reduce the risk of stroke.

More than 10% of people over 65 have AF, with around half of those known to be at risk of stroke taking anticoagulants. Yet two-thirds of people admitted to hospital with a stroke caused by AF are not taking the recommended anticoagulants.  

Last year, NICE published guidelines on AF which included recommendations on using warfarin or non-vitamin K oral anticoagulants (NOACs) to prevent stroke or early death.

The guideline said that GPs should offer warfarin or NOACs where appropriate. Options for anticoagulation should be discussed with the person, and the choice should be based on clinical features and preferences.

The new tool can help both GPs and their patients with this choice. The first part allows GPs to enter health information about a particular person into the online tool, which then provides individualised prescribing recommendations based on the NICE guideline.

The second part incorporates NICE's patient decision aid, to help healthcare professionals support the person with AF weigh up the possible benefits, harms, advantages and disadvantages of different treatment options.

The tool is among several new resources developed by external organisations that have been given the seal of approval from NICE’s new endorsement programme.

The programme aims to ensure that:

  • Users are confident that using an endorsed resource will support implementation of the relevant NICE guidance recommendations or use of the quality standards identified.
  • External producers who are developing support resources have the opportunity to work with NICE to ensure their resources are aligned to NICE recommendations.

Developed by the Centre for Medicines Optimisation at Keele University’s School of Pharmacy in collaboration with Boehringer Ingelheim, the tool will be evaluated in practice as part of a NICE and Keele University research programme.

An “innovative resource” for healthcare profs and people with AF

Paul Chrisp, Director of the medicines and prescribing programme at NICE said: "This tool is an innovative resource for the healthcare professionals and people with AF. It supports the recommendations in our guideline on this important condition, and we're pleased to endorse it."

“Whilst not intended to replace a healthcare professional's clinical judgement it does support clinical decision making. Most importantly it also provides a practical basis for people with atrial fibrillation to have informed discussions with their doctor or nurse about the choices they have when it comes to appropriate management of their condition to reduce their risk of having a stroke, a vital element of patient-centred care."

Professor Stephen Chapman from the Centre for Medicines Optimisation at Keele University said: “This is a great example of a university bridging the public and private sector with a project that benefits all parties by supporting evidence based prescribing. Computerised decision support tools have been shown to improve implementation of clinical guidelines.

“This tool to support prescribing for AF will help distill  the evidence from NICE guidance and tailor it to the needs of the individual patient. Importantly it generates user-friendly visual aids that the doctor and patient can share, thus increasing the patient’s understanding of the risks and benefits of treatment and in this way make it more likely that patients will stick with their treatment plan.”

Professor Klaus Dugi, Medical Director, Boehringer Ingelheim UK and Ireland added: "Treating patients with atrial fibrillation can be complicated for doctors and nurses. They need to weigh up multiple factors and balance out increased risk their patients have of having a stroke with the type of treatments available.

“This innovative tool will help simplify and manage this, by ensuring that treatment recommendations are made jointly by the doctor and patient.”

 

This tool to support prescribing for AF will help distill the evidence from NICE guidance and tailor it to the needs of the individual patient.

Professor Stephen Chapman from the Centre for Medicines Optimisation at Keele University