Atrial fibrillation: NICE updates quality standard

The National Institute for Health and Care Excellence (NICE) has issued an updated quality standard which focuses on identification and management of Afib in adult patients with respect to high-quality care in priority areas for improvement. Paroxysmal, persistent and permanent Afib and atrial flutter are covered in the scope of the condition.

The key goals of the quality standard are:

• Improving mortality rates in individuals with Afib.
• Lowering stroke and transient ischaemic attack rates in with patients with Afib.
• Lowering admission rates for those with a primary diagnosis of Afib.
• Improving QoL of individuals with Afib.

The quality standard covers 6 recommendations:

• Patients with non-valvular Afib and a CHA₂DS₂-VAS_C stroke risk score ≥2 should be offered anticoagulation.
• Patients with Afib should not be prescribed aspirin as monotherapy for stroke prevention
• Patients with Afib prescribed anticoagulation should discuss the options with their clinician at least once a year.
• Patients with Afib with poor anticoagulation control on vitamin K antagonists need reassessment of therapy.
• Patients with Afib with symptoms uncontrolled by current treatment should be referred for specialised management within 4 weeks.
• Patients with Afib receiving long-term vitamin K antagonist therapy should be trained to self-manage with a coagulometer.

Health professionals should also take into consideration several other quality standards including those on cardiovascular conditions, diabetes, stroke, physical activity and alcohol-use disorders when providing services for Afib.