OBJECTIVES: Implement the online Anticoagulant Value Optimisation Tool to calculate detection and treatment opportunity gaps for non-valvular atrial fibrillation (AF), and determine the level of improvement needed to meet the NHS Long Term Plan (LTP) detection and treatment targets.

METHODS: The tool informs Clinical Commissioning Groups (CCGs) in England about the number of registered cases of AF versus the expected number (detection gap) and the number of AF patients at high risk of stroke not receiving adequate anticoagulation (protection gap). Multiple CCGs may be displayed and are ranked from the largest to smallest gap in each category. Currently, the tool is populated with Quality and Outcomes Framework 2018/19 data. Pareto curve analysis in Excel was used on exported outputs to calculate the numbers needed to close the detection gap by 85% and the protection gap by 90%, in line with the LTP targets.

RESULTS: Across all 191 CCGs in England, the detection gap was 230,922 cases of AF (range 9,210 to 11 cases undetected per CCG). To achieve 85% more detection, 123 of 191 CCGs would have to increase the number of AF cases identified by at least 802; 40 CCGs would need to improve by more than double that number. The overall protection gap was 142,930 (range 3,960 to 76 patients per CCG not started on adequate anticoagulation). To achieve 90% improvement, 145 of 191 CCGs would need to prescribe adequate anticoagulation to at least 419 more patients, and 15 would have to increase the number by more than twice that value.

CONCLUSIONS: Current detection and protection gaps indicate the continued need to improve the management of AF in England to meet LTP targets. Action will be needed to achieve a sustainable diagnosis and anticoagulation service.