Case study: Tackling local health inequalities experienced by people with Atrial Fibrillation

Partners: NHS England’s InHIP, the Accelerated Access Collaborative, the Health Innovation Network, NW London Integrated Care Board (ICB)

The national Innovation for Healthcare Inequalities Programme (InHIP) aims to address local healthcare inequalities experienced by deprived and other under-served populations. Delivered by all 15 health innovation networks, in NW London we worked with the ICB to focus efforts on improving treatment of Atrial Fibrillation (AF) in deprived areas. This national initiative also aligned with Mission 1, optimising care for CVD. AF is the most common cardiac arrhythmia and a major cause of stroke.  

Applying a clinical effectiveness approach, the project aimed to identify, address, and minimise healthcare inequalities by increasing access to innovation – in this case, the use of DOAC (Direct Acting Oral Anticoagulant) medication to treat AF. The three-stage approach comprised: 

  • Discover (January ‘23) 
    In collaboration with the NW London CVD Clinical Reference Group (CRG) and AF Working Group, we conducted in-depth data analysis to identify local inequities linked to AF. Findings demonstrated that people living in areas of higher deprivation were less likely to be prescribed DOACs for their diagnosis of AF.  
  • Design (April ‘23) 
    We engaged local clinicians working in areas of high deprivation in NW London to explore their challenges in treating patients with AF, and to understand the drivers of inequalities from a patient perspective, before identifying enablers to improve AF treatment.  
  • Delivery (August ‘23) 
    We facilitated targeted review sessions to increase DOAC prescriptions, supported by development of bespoke data and insights packs, as well as education sessions including a dedicated AF case-finding webinar (see page xx). 

The targeted review sessions resulted in an increase of DOAC prescriptions for patients living in deprived areas of NW London, and helped positively impact the local AF pathway.  

  • Of 218 patients reviewed, 6% were booked appointments to commence DOACs, with a further 26% referred for further review 
  • 3 out of 5 Primary Care Networks (PCNs) involved indicated that they will continue to review AF patients for DOAC eligibility as part of existing processes 
  • 3 out of 5 PCNs involved reported staff members feeling more confident reviewing anti-coagulation following the sessions