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You are here: Home / Resources / SystmOne Resource Centre / SystmOne Specialties / Cardiovascular Overview / Atrial Fibrillation (AF)

Atrial Fibrillation (AF)

Initially created to support the implementation of a regional AF collaboration in the North East and North Cumbria region, the CDRC Precision AF suite of resources contains Searches, Templates and Targeted Alerts. These digital resources help to improve the rates of diagnosis and management of patients with Atrial Fibrillation and further support clinicians with safe anticoagulant prescribing and monitoring.

Accessing CDRC resources on SystmOne

To access the below resources you will need to be a member of the DCS group on SystmOne. To do this, please follow the instructions on theCDRC SystmOne Access webpage.

Screening

AF Screening

General screening for Atrial Fibrillation (AF) is not recommended. Screening is recommended for some patients with high risk conditions such as heart failure.

Screening At Annual Reviews 

The CDRC Core Data Template includes a pulse check entry. This will ensure that people with LTCs are screened for AF. 

Screening During Influenza Reviews 

The Influenza Vaccination Template includes some quick action buttons to record pulse rhythm. 

Additional Screening 

CDRC can be configured to show alerts to prompt clinicians to screen for AF. 

A Patient Status Alert (PSA) is available that displays the following icon to the right of the CDRC GMS icon: 

Clicking on the link opens the Core Data Template to allow pulse rhythm to be recorded. 

This PSA is currently built on a specification from Durham County Council: 

  • Over 75y 
  • Not of AF register 
  • Not on CHD, CKD3-5, diabetes, heart failure, stroke/TIA registers 
  • No pulse check in the last 50 months 

This specification could be altered or customised for local areas if needed 

The PSA is currently enabled for all practices in North Durham and DDES CCGs. 

 

Reports

Detecting un-coded AF

Several reports are available to identify patients who may have undiagnosed or un-coded atrial fibrillation/flutter. 

One particularly useful strategy is to set these reports to run in a batch process (Automated Reporting) to go your cardiovascular/AF lead at regular intervals (6 to 12 monthly is a reasonable frequency). 

A spreadsheet is available to support the drug to diagnosis audits Drug to Diagnosis Spreadsheet – Cardiac

These reports are in the folder CDRC Quality > Cardiovascular 

Report NameReturns Notes
? AF 2.1 Casefinding – Medication that might be for AF but no AF code Patients on rate limiting calcium channel blockers, beta-blockers, digoxin or amiodarone without obvious coded indication for these drugs.  Also likely to detect patients with other uncoded diagnoses such as hypertension and heart failure  NB – the drug to diagnosis searches below find the same patients and are easier to use. 
? AF 2.2 Casefinding – AF potential indicator but no AF code Patients with Read codes suggestive of AF but no QoF code e.g. H/O Atrial fibrillation. Use the QoF CDRC Template (AF page – Non QoF AF Codes panel) to identify the relevant codes. 
? AF 2.3 Casefinding – Irregular pulse but no subsequent ECG Patients who have an irregular pulse without a subsequent ECG. Some of these patients will have erroneous entries of irregular pulse. 
? AF 2.4 Casefinding – AF marked as resolved Patients who have previously had AF which is currently marked as resolved. AF resolved should not be used for patients with paroxysmal AF who are not currently in AF.
? Drug to Diagnosis 002 – Antiarrhythmics without obvious indication  Also likely to detect other diagnoses such as heart failure, SVT, VT. 
? Drug to Diagnosis 004 – Betablocker without obvious indication  Also likely to detect other diagnoses such as hypertension, heart failure, SVT, CHD. 
? Drug to Diagnosis 005 – Calcium channel blocker without obvious indication  Also likely to detect other diagnoses such as hypertension, Raynauds, SVT, CHD. 
? Drug to Diagnosis 008 – Anticoagulants without obvious indication  Also likely to detect other diagnoses such as VTE, mechanical heart valves. 
AF Quality Improvement

The following searches are available to help improve the care of patients with atrial fibrillation.  One particularly useful strategy is to set these reports to run in a batch process (Automated Reporting) to go your cardiovascular/AF lead at regular intervals (1-2 monthly is a reasonable frequency). 

These reports are in the folder CDRC Quality > Cardiovascular 

Report NameReturns Action 
? AF 3.1 Case management – AF without CHADSVASc or possibly incorrect score Patients with AF who do not have a CHADSVASc score or whose most recently recorded score may be incorrect. Review patient and add/update score if appropriate. 
? AF 3.2 Case management – Consider Anticoagulation Patients with AF and moderate or high stroke risk who are not anticoagulated and do have an expiring exception in the last year or a persistent exception. Review the patient and consider anticoagulation or record exception if appropriate. 
AF Performance Searches

The AF Dashboard provides an overview of AF management at a particular unit or group of units. 

These reports are in the folder CDRC Performance > Cardiovascular 

1 Prevalence 
AF - Low risk (latest recorded) 
AF - Low risk (latest recorded) - Anticoagulated 
AF Low risk (calculated) 
AF - Low risk (calculated) - Anticoagulated 
AF 211 - Moderate risk (latest recorded) 
AF 2111 - Moderate risk (latest recorded) - Anticoagulated 
AF 211 2 - Moderate risk (latest recorded) - Anticoagulated or good reason why not 
AF 212 - Moderate risk (calculated) 
AF 2121 - Moderate risk (calculated) - Anticoagulated 
AF 2122 - Moderate risk (calculated) - Anticoagulated or good reason why not 
AF 231 - High risk (latest recorded) 
AF 2 311 - High risk (latest recorded) - Anticoagulated 
AF 2 312 - High risk (latest recorded) - Anticoagulated or good reason why not 
AF 2 32 - High risk (calculated) 
AF 2 321 - High risk (calculated) - Anticoagulated 
AF 2 322 - High risk (calculated) - Anticoagulated or good reason why not 
AF 241 - High or Moderate risk (latest recorded) 
AF 2411 - High or Moderate risk (latest recorded) - Anticoagulated 
AF 2412 - High or moderate risk (latest recorded) - Anticoagulated or good reason why not 
AF 242 - High or Moderate risk (calculated) 
AF 2421 - High or Moderate risk (calculated) - Anticoagulated 
AF 2422 - High or moderate risk (calculated) - Anticoagulated or good reason why not 
AF 3 CHAOSVASc appears up to date 
AF 4- Patients with L TC with high risk of AFI without AF 
AF 4- Patients with L TC with high risk of AFI withoutAF - pulse check in last 12m 
142 
24% 
2 221% 
2 221% 
7 
7 
7 
7 
126 
887% 
120 
g52% 
125 
gg2% 
126 
887% 
120 
g52% 
125 
gg2% 
133 
g37% 
127 
g55% 
132 
gg2% 
133 
g37% 
127 
g55% 
132 
gg2% 
141 
gg3% 
1284 
212% 
1086 
835%
AF QoF Support

The following elements of the CDRC AF system will help with QoF performance. 

Use the searches highlighted in the ‘Detecting un-coded AF’ node above – this is because QoF payments are linked to prevalence so payments are higher if prevalence is higher.

These QoF reports are located in the folder CDRC Contracting > QoF

AF006 – CHADSVASc score recorded in the last 12m (low/moderate risk patients) 

Report NameAction Notes 
AF006 CHA2DS2-VASc in last 12m 1.2 EOY Not Achieved  The CHADSVASc score can be added quickly from the AF template Ideally add this to a batch report for the beginning of Q3 

AF008 – Anticoagulation in the last 6m for patients with AF and CHADSVASc >=2 

The following reports will identify patients to review to improve this indicator. 

Report NameAction Notes 
AF008 CHA2DS2-VASc >2 + anticoagulated 1.11 EOY – WORK TO DO – Update CHADSVASc to achieveThe CHADSVASc score can be added quickly from the AF template Simple addition of the CHADSVASc score will mean the patient achieves this indicator 
AF008 CHA2DS2-VASc >2 + anticoagulated 1.113 EOY – WORK TO DO – Possible undiagnosed high risk AF – on anticoagulantsReview the record to see if AF diagnosis has been missed / miscoded. These patients are already on anticoagulation e.g. has code for ECG: Atrial fibrillation but no QoF AF code. The coding tab of the AF template will help to show non-QoF codes 
AF008 CHA2DS2-VASc >2 + anticoagulated 1.114 EOY – WORK TO DO – Possible undiagnosed high risk AF – not on anticoagulantsReview the record to see if AF diagnosis has been missed / miscoded then consider offering anticoagulation if AF confirmed The coding tab of the AF template will help to show non-QoF codes 
AF008 CHA2DS2-VASc >2 and anticoagulated 1.2 EOY – Excepted Review these patients who are already excepted and consider if anticoagulation would be appropriate  
AF Recommended Batch Reporting

Consider running the follow reports in automatic batches so the relevant professional or group are notified about patients to review at appropriate interval.  For more details on setting this up see Automated Reporting 

AF Management

Monthly Batch 

Report NameLocationReturns Notes 
? AF 3.1 Case management – AF without CHADSVASc or possibly incorrect score CDRC Quality > CardiovascularPatients whose CHADSVASc score (based on the information in the record) appears to be different from the recorded score Use the CHADSVASc button on the AF template to record the score 
? AF 3.2 Case management – Consider Anticoagulation CDRC Quality > CardiovascularPatients with AF – consider anticoagulation Review record / patient 

AF Detection

Annual Batch (ideally at the beginning of Q4) 

Report NameLocationReturns Notes 
? AF 2.1 Casefinding – Medication that might be for AF but no AF code  CDRC Quality > CardiovascularPatients with medications that might be for AF rate control without an obvious reason Review record. Consider appropriate coding. 
? AF 2.2 Casefinding – AF potential indicator but no AF code CDRC Quality > CardiovascularPatients who are not on the AF register with a code that might suggest AF e.g. H/o atrial fibrillation Review record using the AF coding tab of the AF template. Consider adding AF codes or marking erroneous codes in error. 
? AF 2.4 Casefinding – AF marked as resolved CDRC Quality > CardiovascularPatients marked as AF resolved Review records and consider need to mark AF Resolved code in error. More information. 

AF Management

Report NameLocationNotes
AF006 CHA2DS2-VASc in last 12m 1.11 EOY – WORK TO DO CDRC Contracting > QoFNecessary for QoF but doesn’t help patient management 
Use the AF Template to add CHADSVASc scores 

Template

Atrial Fibrillation Template

The Atrial Fibrillation AF CDRC Template provides an overview of Atrial Fibrillation/Flutter management.

How to Access

In the lower left hand corner use the search bar, type in ‘Atrial Fibrillation AF CDRC’ and select the following template:

Alternatively, press F12 and search for ‘Atrial Fibrillation AF CDRC’, this will return the aforementioned template.

The Home Page will be used on most occasions. 

Machine generated alternative text:
AF Investigation Referral 
Atrial Fibrillation 
NICE AF Pathwav 
Atrial Fibrillation Overview 
AF Review 
Exceptions 
Resources aoF Ruleset 
Atrial Fibrillation Overview 
Entered by 
FORBES, Gareth (Dr) (General Medical Practitioner) 
08 20181030 
Non-valvular AF 
Paroxysmal 
Rate control 
Yes 
Cardiology FRH 
Yes 
Unlicensed rivoroxaban recommended by cardiology October 201 6 
Atrial Fibrillation OveMew 
Valvular/Non-valvular 
AF Type 
Pulse control strategy 
Seen by specialist? 
Specialist's details 
Currently under specialist? 
Any other information 
Medication Timeline 
2016 
Pulse Control 
Pulse rate 
Pulse rhythm 
Stroke Risk 
Calculate CHADSVasc Score 
calculate HASSLED score 
Stroke Prevention for Atrial Fibrillation 
Anticoagulation Template 
Anticoagulation Exceptions 
Qof - Achieved 
Not done in the last year 
QoF - not applicable (low CHADSVasc) 
Cryoablation operation for arrhythmia CXOI 
CHA2DS2-vascular disease, 1 
HASBLED not recorded 
Current Antiplatelets/Anticoagulants 
Rivaroxaban 2CL„ 1 g 
! NO CLEAR INDICATION FOR DOAC ! 
08 sep 2018

The top panel allows the user to provide a summary of AF management e.g. AF type, rate vs rhythm control status, who is currently involved in care, any narrative information. 

The Pulse Control panel allows recording of current pulse rate and rhythm. The right hand box will show: 

  • Rate and rhythm control drugs (beta-blockers, rate limiting calcium channel blockers, digoxin, amiodarone and other antiarrhythmics such as flecainide and propafenone. 
  • Previous relevant cardiovascular procedures such as cardioversions and ablations. 

The Medication Timeline button will display previous medication so it possible to see when previous treatments were started/stopped. 

Machine generated alternative text:
ASPIRIN 
ATORVASTATIN 
CLONIDINE 
DIGOXIN 
FLECAINIDE ACETATE 
FUROSEMIDE 
LISINOPRIL 
SIMVASTATIN 
SOTALOL 
TAMSULOSIN HYDROCHLORIDE

The Stroke Risk panel is divided into three columns: 

  • Column 1 – Links 
    • Link to CHADSVASc Calculator 
    • Link to HASBLED Calculator 
    • Link to Cardiovascular Network Guidance on anticoagulation decision making. 
    • Link to Anticoagulation template 
    • Link to information about Anticoagulation Exceptions 
  • Column 2 – Current information 
    • Current CHADVASc score. An alert is displayed if the current estimated CHADSVASc score is different to the most recently recorded score 
CHA2DS2- vascular disease, agn 3 
08 Nov 2018 
OOF 
Stroke Risk 
Calculate CHADSVasc Score 
calculate HASSLED score 
- Not Applicable 
Current recorded score is different to estimated score 
Hyperlen, abnorm renal/lwer functv„2 
24 Jul 2015 
Not done in the last year —
  • Current HASBLED score 
    • Current antiplatelets/anticoagulants 
      • The following information is also displayed in this box: 
      • Recent expiring exception 
      • Persistent exception 
      • Evidence of poor concordance with anticoagulation treatment 
      • Evidence of poor warfarin control 
      • Evidence that DOAC treatment might need to change e.g. dose reduction/significant interactions. 
Stroke Prevention for Atrial Fibrillation 
Anticoagulation Template 
Anticoagulation Exceptions 
Current Antiplatelets/Anticoagulants 
Apixaban 5mg 21 
! SUSPECTED LOW CONCORDANCE 
! CONSIDER DOSE REDUCTION
  • Column 3 – performance indicators 
    • QoF AF006 indicator – CHADSVASc recorded 
    • HASBLED 
    • QoF AF007 indicator – patients with CHADSVASc >=2 treated with anticoagulation (example below) 
CHA2DS2 
- vascular disease, agn 
26 Oct 2018 
Stroke Risk 
Calculate CHADSVasc Score 
calculate HASSLED score 
Stroke Prevention for Atrial Fibrillation 
Anticoagulation Template 
Anticoagulation Exceptions 
Oof - Achieved 
Not done in the last year 
QoF - Excepted 
HASBLED not recorded 
Current Antiplatelets/Anticoagulants 
Aspirin 75mg tam 30 
tan 2 
Prasugrel 10mg„ 30 
tan 2 
Record of anticoagulant not indicated

CHADVASc Calculator

The CDRC system uses the system-wide TPP CHADSVASc calculator. However, there are some significant flaws in the TPP calculator (detailed below).  This CDRC link will first run checks to look for these problems and provide warnings, allowing the user to adjust the CHADSVASc score if needed. 

CHADSVASc / CHAOS 
This tool is only applicable to patients who are diagnosed with 
either Atrial Fibrillation or Atrial Flutter 
alculate @ CHADSVASc O CHAOS 
C 
A 
S 
V 
A 
Congestive heart failure (I pt) 
Hypertensive (I pt) 
D Age 75 (2 pts) 
Diabetic (I pt) 
Z] Stroke or TIA (2 pts) 
Vascular disease (I pt) 
Z] Age 65-74 (1 pt) 
Z] Sex category female (I pt) 
Score = 4 Save to Record 
High Risk of Stroke 
Consider oral anticoagulant
About 
Please note there is a risk of under-estimation of the CHADSVasc score 
as this patient has a record of a pulmonary embolus which isn't recorded 
as a thromboembolism. 
If this patient had a pulmonary thromboembolism consider recoding it as 
such so this code is counted by the CHADSVasc calculator

Potential Issues With TPP CHADSVASc Calculator 

IssueDescriptionEffectAction
Over diagnosis of hypertension TPP calculator counts codes such as white coat hypertension and pregnancy induced hypertension as ‘currently hypertensive’ Potential overestimate Manually reduce score if the patient is not hypertensive 
Over diagnosis of diabetes TPP calculator counts codes such as metabolic syndrome as ‘currently diabetic’ Potential overestimate Manually reduce score if the patient is not diabetic 
Underdiagnoses of heart failure, hypertension, stroke/TIA TPP calculator does not include some codes for these conditions Potential underestimate Manually increase score if the patient has one of these conditions 

HASBLED Calculator

Stroke vs Bleeding Risk

Anticoagulation Exceptions

This template shows anticoagulation exceptions. 

‘Expiring’ exceptions are shown in the top half and ‘persisting’ exceptions in the lower half 

The Investigations Page page shows recommendation for testing and relevant information from the record. 

AF Investigation 
•Assess for signs and symptoms of underlying causes ofAF, including 
ocardiac hypertension, valvular heatl disease, heatl failure, and IHD 
oRespiratory, chest infections, PE, and lung cancer 
oSystemic causes, such as excessive alcohol intake, thyrotoxicosis, electrolyte 
depletion, infections, and diabetes mellitus 
•Review ECG for underlying cause ofAF, such as old ML 
•Consider arranging the following to identify other causes of AF 
0TFTs 
OF8C 
olJ+E, calcium, magnesium, and glucose 
oEchocardiogram ifthere is high risk or suspicion of: 
underlying structural heatl disease (such as a heatl murmur) 
functional heatl disease (such as heatl failure) 
that will influence subsequent management (for example choice of antiarrhythmic drug) 
OCXR if lung pathology (such as lung cancer or pneumonia) is suspectel 
Cardiology Examination 
serum TSH level 
Latest Renal 
Serum creatinine level 
GFR calculated abbreviated 
Latest FBC 
Haemoglobin concentration 
Total white blood count 
Platelet count- observation 
Lastest Calcium 
M 
O miu/L 
go umol/L 
80 mLJmim 
14 8 g/dL 
long/ 
2g4 1 one/ 
26 Feb 2018 
06 Nov 2018 
06 Nov 2018 
og Mar 2018 
og Mar 2018 
og Mar 2018 
Serum adjusted calcium conc 
Latest Magnesium 
Serum magnesium level 
2 33 mmoI/L26 Feb 2018 
Not 
DCS CXRview has no data for patient 
24 Aug 2018 
Notes 
Echocardiogram shows left ventricular s 
Patient reports that he had two echco whilst 
inpatient at FRH first on admission second 
pre discharg4 Discharge letter reports LV 
function as moderate (30-50) % but ICO 
card EF as poor

The AF Referral Page page shows referral guidance.

Additional Resources

AF Resolved

Many patients with ‘resolved’ atrial fibrillation remain at increased risk of thromboembolic disease and should often be managed as if they have AF.  The following guide for the management of people with past, transient or intermittent AF is put together by consensus of the North East and North Cumbria Cardiovascular Network. 

Paroxysmal AF These patients usually retain a long term higher risk of stroke Retain on the AF register and manage as AF unless instructed by a specialist – i.e. anticoagulation based on CHADsVASc vs bleeding risk assessment 
AF related to hyperthyroidism Long term risks of recurrence and thromboembolism are likely to be similar to background population For patients whose only risk for AF is hyperthyroidism and where the AF resolves with successful treatment of the hyperthyroidism, mark the AF as resolved.  Most commonly this affects young, otherwise healthy women. 
AF and cardioversion/other procedures Patients remain at significantly higher risk of thromboembolism from AF after successful ablation/cardioversion procedures Unless otherwise advised by a specialist, do not mark these patients as AF Resolved. They should be managed as if they have AF. 
AF after cardiac surgery Transient AF is common after cardiac surgery such as CABG Take advice from cardiology about whether these patients should be included on the AF register. 
AF due to other stresses Transient AF is not uncommon during other stresses such as non-cardiac surgery or infection. Take advice from cardiology about whether these patients should be included on the AF register. 

The AF Template can help to record such reviews – in the Overview section 

AF Investigation Referral 
Atrial Fibrillation 
Atrial Fibrillation Overview 
AF Review 
Coding Exceptions Resources aoF Ruleset 
O NICE AF Pathway 
CORC Manual patient Information 
Atrial 
Enter 
27 Jan 2022 1634 
Atrial Fibrillation Overview 
Entered by 
FORBES, Gareth (Dr) (General Medical Practitioner) 
Pulse Control 
Pulse rate 
Pulse rhythm 
Stroke Risk 
Calculate CHADSVasc Score 
calculate HASSLED score 
calculate ORBIT score 
AF Stroke vs Bleeding Risk 
Anticoagulation Template 
Anticoagulation Exceptions 
Atrial Fibrillation OveMew 
Valvular/Non-valvular 
AF Type 
AF Type Details 
Seen by specialist? 
Currently under specialist? 
Medication Timeline 
CDRC AF Pulse control view has no data for patient 
CHADSVasc Score Not Recorded 
20 Nov 2018 CHA2DS2- vascular disease, 
HASBLED not recorded 
ORBIT score Not Recorded 
No record of repeat antiplatelet or anticoagulant 
Not known 
Other 
Brief episode ofAF during treatment for brain haemorrhage 
CDRC AF CHADSVASC QoFview has no data 
Not done in the last year 
Not done in the last year 
CDRC AF Anticoagulation OOF view has no dat
Opt-in Resources

For practices who have recently joined the DCS group on SystmOne, PSAs and Protocols will not be automatically active. You can choose the level of activation you would like; opt-in to all or resource specific CDRC resource PSAs and Protocols. Alternatively you can choose not to opt-in and only use the Reports and Templates.

If you would like to activate that following, or all, CDRC PSAs and Protocols, please email contact-cdrc@ahsn-nenc.org.uk

The AF Bundle of opt-in resources includes: 

Patient Status Alert:

This PSA highlights whether the patient has AF.

Protocols:

Protocol TitleTriggerAction
AF Casefinding – Irregular Pulse AUTO S Open patient with last pulse check irregular without subsequent ECG Prompts user to check pulse rhythm +/- ECG 
AF Casefinding – AF Potential Ind Added AUTO S Triggers when a non-QoF potential AF indicator is added to a patient without AF (e.g. ECG:AF) Prompts the user to consider coding AF 
AF Casefinding – AF Potential Proc Added AUTO S Triggers when a cardiac arrhythmia procedure is added to a patient without an obvious reason Prompts the user to consider adding appropriate codes 

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