Bradford leads the way with ground-breaking stroke project

A ground-breaking project led by Bradford clinicians has led to fewer people suffering devastating strokes.

The innovative improvement project involved patients living with the potential ticking-time bomb of Atrial Fibrillation – usually referred to as AF. The condition, which causes abnormalities in the rhythm of the heart, puts them at risk of sudden cardiac arrest, heart attack or stroke.

AF patients, earmarked as being at moderate to high risk of stroke, were prescribed anticoagulation drugs such as Warfarin, as a precautionary measure, resulting in a reduction of two strokes per month across Bradford and Airedale – or 24 strokes per year.

And the number of averted strokes is set to rise as more patients are involved in the project, believed to be the first of its kind in the UK.

Dr Matt Fay, GP specialist in cardiology, who led the project said: “This is a proud day for Bradford GPs who took the lead in recognising and embracing a vitally important health issue.

“As far as I am aware no-one else anywhere has undertaken a project such as this which has resulted in a dramatic positive effect on the health of patients. All strokes are devastating but AF strokes are bigger and potentially lethal. Sadly, 15% of people who suffer an AF stroke die during the hospital admission and 50% of sufferers will need long-term care.

“But we know that when prescribed anticoagulant drugs, these strokes can be avoided. We have always known this yet too many patients are still being given aspirin when they could be given anticoagulants. Bradford has now shown the way with this project and this new evidence is the best yet for patients.

“Two strokes fewer per month may not sound a lot but this is just the beginning. This figure will rise as the project continues, and if it were to be adopted by other CCGs across the country and the UK, the impact for AF patients will be life-changing.”

The project ran for 18 months, concluding in April 2013 with the final analysis of results just being collated. It was rolled out by more than 60 GP practices in Bradford City, Bradford Districts and Airedale, Wharfedale and Craven Clinical Commissioning Groups (CCGs.)

Across the three CCGs, there are 6,000 AF patients with around 5,000 of them deemed moderate to high risk of stroke. However, only 2,300 were already being prescribed anticoagulation drugs as a precautionary measure.

The project targeted more than 750 new patients who were given anticoagulants, resulting in fewer strokes. More patients in the moderate to high risk category will now be involved as the project is rolled out.

Predicted figures by Dr Fay and the team reveal that ultimately the project will result in 200 fewer strokes in Bradford and district alone; 800 across West Yorkshire; 5,000 across England and as many as 10,000 across the UK.
Greg Fell, consultant in public health, who was also involved in the project said: “This is an example of CCGs taking the lead, seeing success and changing the face of the NHS.

“This project is way in advance of anything that has been achieved in this country or anywhere else, and this good work must continue.

“NICE has just released revised guidelines which support the use of anticoagulants for AF patients, which only goes to endorse the importance of this project and how Bradford GPs have had the vision to lead the way.”

Case study
Eldwick resident, Barbara Edwards, 65, knows only too well the trauma of AF and its repercussions. But now thanks to the project she is on the road to recovery.

Barbara suffered a stroke on 30 December 2012. When she was admitted to hospital, the triage nurse noticed that she had an irregular heartbeat and she was diagnosed with Atrial Fibrillation (AF),a condition that is often hereditary.

On further investigation Barbara discovered that relatives on her father’s side of the family had suffered stroke and Transient Ischaemic Attacks (TIAs

Talking about her experience, Barbara said: “We had had quite a busy Christmas and I felt a bit off it but thought I must have a urinary infection.  I woke up in the night and walked straight into the bedroom wall. Then in the morning I asked my husband, Terry, for a cup of tea and then asked him again to get one for me. He said he had already brought it and put it on the bedside table – I could see my water and Olbas Oil but couldn’t see the tea.”

She ended up going to Westcliffe Medical Practice where she met the on-call GP, Dr Matt Fay. “On my way there, I bumped into several wing mirrors in the car park and nearly fell over someone in the waiting room – they thought I had been celebrating a bit too much!” Barbara said.

“My most significant symptom of the stroke was spatial awareness – it was my brain that was affected rather than my sight,” she said. Barbara spent two nights in hospital. “People’s attitudes were lovely and they all had a really calming effect on me,” she said. “It made what was a very difficult and frightening situation less so.”

Barbara was not aware of AF – and certainly didn’t know she had it. “It was a great surprise to me to find out that I had AF – it had not been picked up before,” she said. “It has been important for me to know so that I can manage it with the right medication.

“I’m sure a lot of people suffer from AF but are not aware of it. I think people need to know,” said Barbara. “You can’t stop AF but you can manage it, if you know about it.”