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RAIDR's potentially undiagnosed AF

PMM 21/08/18

INTRODUCTION

As part of the Quality Improvement Scheme (QIS) this year we need to contribute reducing the estimated prevalence gap for AF in Leeds, estimated in 4624 people

CRITERIA

  • Patients identified as potential AF need records checking and diagnosis made based on ECG/cardiology letters

METHODS

Using RAIDR, 57 patients were identified as with codes that would suggest the possibility of an undiagnosed AF.

RESULTS

  • One deceased patient
  • One invalid NHS number, so unable to check.
  • Two already known AF somehow not picked by RAIDR.
  • One patient with AF not coded, even though on medication, and seen by cardiology.
  • Seven patients had irregular pulse not followed up.
  • 30 Patients were followed up in practice and ECG indicated:
    • 21 sinus rhythm.
    • 4 sinus bradycardia
    • 1 sinus tachycardia
    • 3 normal.
    • 1 old RBBB
  • One patient had regular pulse and was mis-coded with “ECG: AF” when there was an intention to refer for ECG treadmill.
  • One patient had irregular pulse coded and text indicating it was an ectopic, and under Cardiology.
  • 13 Patients were seen by cardiology as some arrhythmias were found and diagnoses made were
    • 6 SVT
    • 1 VT
    • 1 AVNRT
    • 1 sinus arrhythmia
    • 1 Wolf Parkinson White.
    • 1 No AF, no arrhythmia diagnosis.
    • 1 No AF. IHD diagnosis.
    • 1 Vasovagal syndrome

 

CONCLUSIONS

RAIDR, as expected showed issues with coding and lack of coding. Many ECG findings were not coded, and had to be added. There has been little benefit yet on improving AF prevalence looking at 57 cases and finding 1 not coded, although there are 7 patients that could me undiagnosed.

PLAN OF ACTION

  • 7 Patients to be invited for ECG
  • ECG codes added and errors amended.
  • We shall run again RAIDR next year to assess if the new codes will take them out of the potential list.

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