Exploring and improving the treatment of Atrial Fibrillation in deprived areas of North West London

NHS England’s Innovation for Healthcare Inequalities Programme (InHIP) aims to address local healthcare inequalities experienced by deprived and other under-served populations. ​Nationally, the programme is a unique collaboration between the Accelerated Access Collaborative (AAC), NHS England’s National Healthcare Inequalities Improvement Programme and the Health Innovation Network (HIN) and is being delivered in partnership with integrated care systems (ICSs).

​ In North West London, ICHP worked with NW London Integrated Care System, focusing on improving treatment of Atrial Fibrillation (AF) in deprived areas. 


Our goal was to apply a Clinical Effectiveness approach to improve CVD outcomes in NW London.   

As part of InHIP, we applied a clinical effectiveness approach, utilising data to tackle health inequalities for those in NW London with Cardiovascular disease (CVD), specifically AF. This was part of NW London ICS’ mission to optimise CVD care and treatment. 


 We applied a structured methodology using three-stage approach: Discover, Design and Delivery. 

Discover: Jan 2023
Engaging with the NW London CVD clinical reference group and NW London AF working group, we conducted in-depth data analysis which identified local AF health inequalities, including the finding that patients living in areas of higher deprivation were less likely to be prescribed Direct Oral Anticoagulants (DOACs) for their diagnosis of AF. This led us to focus on local populations living in areas of high deprivation. 

Design: April 2023
We engaged local clinicians working in areas of NW London with high levels of deprivation, to explore their challenges in treating patients with AF, understand the drivers of inequalities from a patient perspective before identifying enablers to improve AF treatment. 

Delivery: August 2023
We facilitated targeted review sessions to increase DOAC prescriptions, supported by development of bespoke data and insights packs as well as an education events including a dedicated AF case finding webinar. 


Our DOAC review sessions resulted in an increase in DOAC prescriptions for patients living in deprived areas of NW London, as well as positively impact the local AF pathway and clinical teams. Of 218 patients reviewed, 13 (6%) patients were booked appointments to commence DOACs, with a further 57 (26%) being referred for further review.  

In the project evaluation, three of five Primary Care Networks (PCNs) involved indicated they will continue to review their AF patients for DOAC eligibility as part of existing processes, and three of five PCNs involved stated their staff members involved felt more confident reviewing anti-coagulation following the sessions.  


Data has enabled the project – we utilised the strength of our local data asset Discover, a de-identified dataset, which links data from over 400 healthcare providers in NW London, to analyse health inequalities for both AF prevalence and DOAC prescriptions. This was combined with broad clinical engagement to add qualitative depth.  

Another enabler has been collaborative engagement with a wide range of stakeholders. This included regular engagement with the NW London AF Working Group, which allowed us to share our insights with a multidisciplinary team from across NW London, as well as review results, and test solutions against the day-to-day realities of primary care in NW London. We also worked closely in partnership with our local Integrated Care Board CVD programme team to share insights and inform other programmes, request support, and receive healthy challenges.  

A programme challenge was that we were unable to progress Patient and Public Involvement (PPIE), as clinical engagement was prioritised for our focus area. The impact of this was mitigated by exploring clinician views on patient challenges, however this would have been strengthened by validating it with targeted PPIE. 

Our main programme challenge was embedding work sustainably without adding significantly to local workload – colleagues flagged that while they were interested, they were lacking time to be more involved. We mitigated this by ensuring our engagement and delivery activities remained flexible, however it should be noted that as we needed to provide additional resources, the approach may struggle to become business as usual, despite the evidence of impact.  

Next Steps

The programme has developed significant data-led insights into AF inequalities, as well as effective relationships with local staff members, that will both continue to demonstrate sustainable benefits through the NW London ICS’ mission to optimise CVD care and treatment using research and innovation. 

The high level of quantitative and qualitative insight into local AF health inequalities generated have been vital in informing our approach to this mission. Relationships that have been built with local stakeholders will also be harnessed for the mission by recruiting Innovation Networks – communities of practice focused on utilising innovation to improve NW London CVD care and treatment. 


If you would like to find out more about this work please email us.