Anticoagulation UK

Out of Range: Audit of anticoagulation management in secondary care in England’.

Illnesses relating to atrial fibrillation (AF), including stroke, cost the NHS over £2.2 billion each year

Illnesses relating to atrial fibrillation (AF), including stroke, cost the NHS over £2.2 billion each year and there are growing concerns about variations in the quality of AF care across England. Anticoagulation UK therefore set out to measure and assess how effectively NHS Trusts are treating and supporting patients with AF, specifically those who are receiving warfarin, and this report sets out both how and why anticoagulation services should be improved.

Through Freedom of Information (FOI) Act requests we have been able to collate information on what measures providers have in place to support optimal anticoagulation patient care. This has revealed several areas where there are variations in care, and where improvements should be made if we are to reduce the incidence of complications such as AF-related stroke.


Our key findings include:

  • Up to 37,878 warfarin patients have been identified as having sub-optimal anticoagulation control and are therefore at an increased risk of stroke or bleeding
  • 29,305 warfarin patients recorded as spending less than 65 per cent of time in therapeutic range (TTR), putting them at an increased risk of stroke
  • 62 per cent of responding Trusts have no written clinical protocols in place for reassessing anticoagulation in AF patients who have poor anticoagulation control

Anticoagulation UK believes that all patients with AF should be able to benefit from high quality treatment and support, regardless of their location. AF is a manageable condition and AF-related strokes are largely preventable through effective and well-monitored anticoagulation therapy. As such, we make a series of recommendations in the report.

Our recommendations include:

  • All national policy documents related to the prevention of AF-related stroke should be updated to make explicit that failure to prescribe an effective anticoagulant should be regarded as a ‘never event’
  • NHS England and Public Health England should publish annual data on progress in increasing the proportion of AF patients who are offered and started on appropriate NICE-approved anticoagulant treatment
  • The NICE clinical guideline (CG180) should be updated to include a clear specification of the information, education and support materials that anticoagulation service providers should be routinely offering to AF patients
Support for Anticoagulation UK with this project has been provided by MHP Health, whose services are paid for by Bayer.  Bayer has checked the content of materials for factual accuracy and compliance with the ABPI code of practice.  Editorial control rests with Anticoagulation UK.

READ THE REPORT