Variation in Anticoagulation treatment Between CCGs: Are Demographic Factors to Blame?

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The problem

Atrial Fibrillation (AF) affects a million people in the UK and is associated with one in eight strokes. More than half of these strokes could be averted if every patient with AF was treated with a suitable anticoagulant therapy.At present, only 69% of patients with atrial fibrillation are treated with anticoagulants (source: QOF data, 2013:14) – a slight rise from 65% in 2012:13. The variance in performance between CCGs nationally remains steady (2012:13, Min 56%, Max 75%, Var 14%, 2013:14, Min 58%, Max 77%, Var 14%). This implies that performance is rising uniformly, but that differences between CCGs are resistant to change. We wished to ascertain whether demographic factors such as deprivation, age and ethnicity explained the variance in performance between CCGs.

The approach

Using the QOF data published in October 2014 QOF and Public Health England data from Nov 2014 we analysed the relationship between demographic factors and anticoagulation treatment at a CCG level.The


We calculated the coefficient of determination (R2) for linear regression models that we fitted to the PHE and QOF data. The data show that demographic factors have little bearing on the variance in performance between CCGs. For the regression model for anticoagulation treatment versus income deprivation. R2=0.005. For anticoagulation treatment versus the proportion of over 65 year olds, R2=0.002. For anticoagulation treatment versus black and minority ethnic population, R2=0.0005.The


Nationally, CCGs have very different levels of performance. Whilst performance has risen in the period between the 2012:13 and 2013:14 QOF exercises, the level of variance has not reduced. Analysis of the QOF and PHE data shows that this variance is not due to income deprivation, age or ethnic mix, therefore the reasons for this persistent variance must lie elsewhere.In a three year CLAHRC-funded project we will evaluate the effect of different packages of behaviour change interventions that are designed to improve anticoagulation prescribing. We aim to identify interventions that can be used to improve performance in the CCGs with the lowest anticoagulation treatment rates.


  • Emma Byrne
  • John Robson