Our software tool ‘APL-AF’ is helping GPs and pharmacists to save lives by ensuring patients with AF are on the most effective medication.
Atrial fibrillation (AF) is a heart condition that causes an irregular heartbeat and blood clots. It is responsible for 1 in 5 strokes.
Anticoagulant medications prevent blood clots from forming. They reduce the risk of stroke in people with AF by more than half, but not all patients who require anticoagulants receive them. In addition, research shows that 2 in 3 patients who are prescribed anticoagulants in combination with antiplatelets (known as ‘dual therapy’) receive the antiplatelets for longer than 12 months. While short term dual therapy is appropriate after a heart attack, taking both clot-preventing medications for a prolonged period increases the risk of life-threatening bleeding, most commonly from the stomach.
The information to identify patients who need to start anticoagulation or stop dual therapy exists in the patient records held by GPs. But the only way to see this data using the health record system is to search for patients with AF and open each record individually to locate the relevant details. This is extremely time consuming.
We developed a data-driven software tool called the ‘Active Patient Link for Atrial Fibrillation’ (or ‘APL-AF’). Using the tool, a GP or pharmacist can import their entire practice register of patients with AF and quickly see key information that indicates whether a medication review is needed. APL-AF displays a list of patients that the clinician can filter to rapidly view specific cohorts – for example, patients who are not anticoagulated; patients who have not had a medication review in the last 12 months; or patients who are prescribed dual therapy.
Without leaving the tool, the GP or pharmacist can click on an individual and ‘virtually review’ relevant factors, including their latest blood pressure reading, other health conditions, and other medications such as statins, that may influence the best course of treatment.
Having this information to hand before delving into the patient record or arranging a consultation saves time and allows clinicians to prioritise the most at-risk patients.— Dr Chris Carvalho, GP and Cardiovascular Clinical Lead, NHS North East London.
Since its launch in 2016 APL-AF has been used extensively in east London and more widely, including several award-winning initiatives. In 2016, in conjunction with Barts Health pharmacists, we implemented the tool in GP practices in the east London borough of Redbridge, which at the time was in the bottom 10 per cent in England for anticoagulation. The proportion of eligible people taking anticoagulants increased from 77 per cent to 83 per cent in the first year - an increase of 290 people. We estimate that in those 290 people, medicines optimisation prevented 30 strokes over the five years that followed.
This programme was then scaled to a further two boroughs - Barking & Dagenham and Havering - this time in collaboration with in-practice pharmacists who had recently been recruited into GP surgeries. They used APL-AF to review the treatment plans of around 10,000 patients with AF. They also set up an educational programme to raise awareness of anticoagulants among pharmacy staff, and an advice service to discuss the most complex patients. Within a year, anticoagulation in AF patients in the area increased to 95 per cent - exceeding the national target of 90.
In 2023, NHS North East London was the best performing region in London for anticoagulation in the national Quality and Outcomes Framework (QOF) performance rankings.
The APL-AF tool has also been used in Enfield, and the patient record searches that drive the tool were incorporated into UCL Partners’ Proactive Care Frameworks, which are now available nationally.
Dr John Robson, Zaheer Ahmed, Isabel Dostal, Karishma Bhuruth and Dr Michael O’Hanlon, in collaboration with Barts Pharmacist team: Jagjot Kaur Chahal, Nadya Hamedi, Sotiris Antoniou, Mital Patel and Paul Wright, and BHR GP lead Shabana Ali and prescribing advisors.
APL-AF was developed as part of REAL-Health Cardiovascular, a major research programme funded by Barts Charity.