Presentation by Priya Ramanah, AF Programme Manager, Imperial College Health Partners: RightCare at The future of innovation in AF and stroke prevention in the NWC, 27 June 2018, Haydock Park Racecourse
Priya Ramanah - The future of innovation in atrial fibrillation and stroke prevention in the NWC
1. NHS Rightcare: tools
for improving
outcomes in AF
Priya Ramanah
AF Programme Manager,
Imperial College Health Partners
2. Screening for AF
Systematic opportunistic screening is
more likely to be cost-effective than
systematic population screening
3. Screening for AF
Nurse pulse palpation or modified blood
pressure monitors with confirmation by
diagnostic 12-lead electrocardiography
interpreted by a trained GP
(with referral to a specialist in the case of an unclear diagnosis)
4. Currently two classes of anticoagulants are available:
âą Vit K antagonists - most commonly warfarin
âą Direct oral anticoagulants (DOACs)
Both are effective, cost effective and are
recommended in treatment guidelines for prevention
of stroke in AF
15. 1. AF Budget Impact Model
2. DOAC Forecasting Model
3. Opportunity Analysis
4. Oral Anticoagulant Value for Money Analysis
Existing tools available today
(links below)
Priya Ramanah
AF Programme Manager at Imperial Health Partners
Welton NJ, McAleenan A, Thom HHZ, Davies P, Hollingworth W, Higgins JPT, et al. Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis. Health Technol Assess 2017;21(29)
https://www.journalslibrary.nihr.ac.uk/hta/hta21290#/abstract
Welton NJ, McAleenan A, Thom HHZ, Davies P, Hollingworth W, Higgins JPT, et al. Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis. Health Technol Assess 2017;21(29)
https://www.journalslibrary.nihr.ac.uk/hta/hta21290#/abstract
https://www.nice.org.uk/guidance/cg180/evidence/atrial-fibrillation-update-full-guideline-pdf-243739981
Guo L et al., (2017) Comparative Efficacy of Clinical Events Prevention of Five Anticoagulants in Patients With Atrial Fibrillation (A Network Meta-Analysis). Am J Cardiol 119(4):585-93.
dabigatran has a noticeable and comprehensive advantage compared to others with respect to preventing several complications including hemorrhage events, myocardial infarction, and mortality. In addition, apixaban may be the best choice of preventing stroke, and rivaroxaban is more preferable to others with respect to preventing vascular event