AF008 - AF on a DOAC

AF008 - AF on a DOAC

The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                     

Indicator definition

Indicator ID

Description

AF008

Percentage of patients on the QOF Atrial Fibrillation register and with a CHA2DS2-VASc score of 2 or more, who were prescribed a direct-acting oral anticoagulant (DOAC), or, where a DOAC was declined or clinically unsuitable, a Vitamin K antagonist.

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the AF008 denominator if:
  1. they are on the Atrial Fibrillation (AF) register.
  2. their most recent CHA2DS2-VASc stroke risk assessment scored 2 or more or patient did not have a CHA2DS2-VASc but their most recent CVD risk assessment was a CHADS2 stroke risk assessment score of 2 or more recorded prior to April 2015.

What must I do to achieve the indicator

Patients will achieve the indicator if:
  1. They have no record of a mechanical prosthetic valve replacement and were prescribed a direct-acting oral anticoagulant (DOAC) in the 6 months up to and including the reporting period end date

  2. Have no record of a mechanical prosthetic valve replacement, were prescribed a Vitamin K antagonist (warfarin) in the 6 months up to and including the reporting period end date and have any of the following criteria:

    1. Have chosen not to receive a direct-acting oral anticoagulant (DOAC) in the contract year

    2. Have a direct-acting oral anticoagulant (DOAC) contraindication code anywhere in their record.

    3. Have an Antiphospholipid syndrome diagnosis anywhere in their record.

    4. Have a direct-acting oral anticoagulant (DOAC) not indicated code in the contract year AND whose last recording of 'Time in Therapeutic Range (TTR)’ was greater than or equal to 65% and recorded in the last 6 months of the contract year.

  3. Have a mechanical prosthetic valve replacement and were prescribed a Vitamin K antagonist in the last 6 months of the contract year.

What will remove patients from eligibility?

  1. Patients who have a mechanical prosthetic valve replacement with no oral anticoagulant issued and either:

    1. a Vitamin K antagonist contraindication code anywhere in their record

    2. have chosen not to receive a Vitamin K antagonist in the contract year

  1. Patients who have no record of a mechanical prosthetic valve replacement replacement as well as a Vitamin K antagonist contraindication code anywhere in their record OR chosen not to receive a Vitamin K antagonist in the contract year as well as one of the following:

      1. a direct-acting oral anticoagulant (DOAC) contraindication code anywhere in their record

      2. a diagnosis of Antiphospholipid syndrome anywhere in their record

      3. a direct-acting oral anticoagulant (DOAC) not indicated code in the contract year

  1. Patients who have no record of a mechanical prosthetic valve replacement AND BOTH OF THE BELOW:

    1. have chosen not to receive a direct-acting oral anticoagulant (DOAC) in the 12 months up to and including the reporting period end date 

    2. have a Vitamin K antagonist (warfarin) contraindication code anywhere in their record or have chosen not to receive a Vitamin K antagonist in the contract year
  1. Patients who have a persisting generic oral anticoagulant contraindication code recorded 
  2. Patients who have an expiring generic oral anticoagulant contraindication code recorded within with contract year
  3. Patients who declined oral anticoagulant medication in the contract year
  4. Patients who were diagnosed with AF in the last 3 months of the contract year
  5. Patients who were newly registered with the practice in the last 3 months of the contract year

If a patient achieves the indicator at any point during the year, any exclusions that have also been added are ignored.

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Stroke risk assessment using CHA2DS2-VASc (CHADVASC_COD)

SNOMED code

SNOMED code description

735259005

Congestive heart failure, hypertension, age 2, diabetes mellitus, stroke 2, vascular disease, age, sex category stroke risk score

793851000000102Congestive heart failure, hypertension, age 2, diabetes mellitus, stroke 2 - vascular disease, age, sex category stroke risk score

Stroke risk assessment using CHADS2 (CHAD_COD)

SNOMED code

SNOMED code description

1085111000000109

Congestive heart failure, hypertension, age 75 years or older, diabetes mellitus and previous stroke or transient ischaemic attack score

763007002Assessment using congestive heart failure, hypertension, age 75 years or older, diabetes mellitus and previous stroke or transient ischemic attack score
763008007
Congestive heart failure, hypertension, age 75 years or older, diabetes mellitus and previous stroke or transient ischemic attack score

Mechanical prosthetic valve replacement codes (MECHVALVREP_COD)

SNOMED code

SNOMED code description

125411000119107
History of mechanical aortic valve replacement (situation)

174929002Mechanical prosthetic aortic valve replacement (procedure)
174937005Mechanical prosthetic tricuspid valve replacement (procedure)
174946004Mechanical prosthetic pulmonary valve replacement (procedure)
232773001Bjork-Shiley prosthetic replacement of mitral valve (procedure)
232923009Mechanical prosthetic atrioventricular valve replacement (procedure)
232951000Mechanical prosthetic truncal valve replacement (procedure)
275030001Ball valve mitral valve replacement (procedure)
275031002Disc valve mitral valve replacement (procedure)
275033004Bileaflet mitral valve replacement (procedure)
275199000Ball valve aortic valve replacement (procedure)
275200002Disc valve aortic valve replacement (procedure)
275202005Bileaflet aortic valve replacement (procedure)
275203000Ball valve tricuspid valve replacement (procedure)
275204006Disc valve tricuspid valve replacement (procedure)
275206008Bileaflet tricuspid valve replacement (procedure)
275207004Ball valve pulmonary valve replacement (procedure)
275209001Disc valve pulmonary valve replacement (procedure)
275211005Bileaflet pulmonary valve replacement (procedure)
308671003Bileaflet atrioventricular valve replacement (procedure)
308673000Ball valve truncal valve replacement (procedure)
308674006Disc valve truncal valve replacement (procedure)
308676008Bileaflet truncal valve replacement (procedure)
33711000119109History of mechanical heart valve replacement (situation)
431339008Mechanical prosthetic mitral valve replacement (procedure)
698545003History of mechanical prosthetic mitral valve replacement (situation)
699347000Mechanical heart valve replacement (procedure)
96271000119109History of mechanical mitral valve replacement (situation)

Vitamin K antagonist contraindicated codes (VITKANTAGCON_COD)

SNOMED code

SNOMED code description

134392003

Warfarin not indicated (situation)

293341000
Indirect acting anticoagulant adverse reaction (disorder)
293342007
Coumarin anticoagulant adverse reaction (disorder)
293343002
Nicoumalone adverse reaction (disorder)
293344008
Warfarin adverse reaction (disorder)
293345009
Indanedione anticoagulant adverse reaction (disorder)
293346005
Phenindione adverse reaction (disorder)
294878002
Allergy to indirect acting anticoagulant (finding)
294879005
Allergy to coumarin anticoagulant (finding)
294880008
Allergy to acenocoumarol (finding)
294881007
Allergy to warfarin (finding)
294882000
Indanedione anticoagulant allergy (disorder)
294883005
Allergy to phenindione (finding)
315061006
Warfarin contraindicated (situation)
403658002
Dermatosis attributable to coumarin anticoagulant (disorder)
403659005
Coumarin necrosis (disorder)
782560008
Allergy to indanedione (finding)
870674008
Adverse reaction to indanedione (disorder)
871777003
Adverse reaction to coumarin (disorder)
88181000000106
Warfarin not tolerated (situation)

    Codes indicating the patient has chosen not to receive a Vitamin K antagonist (VITKANTAGDEC_COD)

    SNOMED code

    SNOMED code description

    134398004

    Warfarin declined

    Direct oral anticoagulant (DOAC) contraindicated codes (DOACCON_COD)

    SNOMED code

    SNOMED code description

    293332005Direct acting anticoagulant adverse reaction
    294870009
    Direct acting anticoagulant allergy
    846181000000104
    Dabigatran contraindicated
    846321000000102
    Dabigatran not tolerated
    912841000000100
    Novel oral anticoagulant contraindicated
    912861000000104
    Novel oral anticoagulant not tolerated
    985211000000107
    Apixaban adverse reaction
    985231000000104
    Rivaroxaban adverse reaction
    985251000000106
    Rivaroxaban allergy
    985271000000102
    Apixaban allergy
    985331000000105
    Apixaban not tolerated
    985351000000103
    Rivaroxaban not tolerated
    985631000000101
    Apixaban contraindicated
    985661000000106
    Rivaroxaban contraindicated

    Antiphospholipid syndrome codes (ANTIPHOSYND_COD)

    SNOMED code

    SNOMED code description

    19267009

    Lupus anticoagulant disorder

    201450008
    Antiphospholipid syndrome
    239892009
    Primary antiphospholipid syndrome
    239893004
    Primary antiphospholipid syndrome with organ/system involvement
    239894005
    Primary antiphospholipid syndrome with multisystem involvement
    239895006
    Secondary antiphospholipid syndrome
    239896007
    Secondary antiphospholipid syndrome with organ/system involvement
    239897003
    Secondary antiphospholipid syndrome with multisystem involvement
    26843008
    Antiphospholipid syndrome
    402865003
    Systemic lupus erythematosus-associated antiphospholipid syndrome
    441079006
    Thrombophilia due to antiphospholipid antibody
    609329007
    Catastrophic antiphospholipid syndrome
    72161000119100
    Antiphospholipid syndrome in pregnancy
    774084003
    Neonatal antiphospholipid syndrome

    Direct oral anticoagulant (DOAC) not indicated codes (DOACNI_COD)


    SNOMED code

    SNOMED code description

    846221000000109

    Dabigatran not indicated

    912881000000108
    Novel oral anticoagulant not indicated

    Codes indicating the patient has chosen not to receive a direct oral anticoagulant (DOAC) (DOACDEC_COD)

    SNOMED code

    SNOMED code description

    912661000000103

    Novel oral anticoagulant declined

    Oral anticoagulant generic contraindication codes (persisting) (XORANTICOAGGENCON_COD)

    SNOMED code

    SNOMED code description

    293331003

    Anticoagulant adverse reaction

    294869008
    Allergy to anticoagulant
    402754004
    Dermatosis resulting from anticoagulant therapy
    67888001
    Transfusion reaction caused by toxic effect of anticoagulant

    Oral anticoagulant generic contraindication codes (expiring) (TXORANTICOAGGENCON_COD)


    SNOMED
    code
    		SNOMED code description

    413558003

    Anticoagulation contraindicated

    413561002

    Anticoagulation not tolerated


    Codes indicating the patient has chosen not to receive oral anticoagulant (generic) (ORANTICOAGGENDEC_COD)

    SNOMED codeSNOMED code description

    413559006

    Anticoagulation declined

    INR Time in therapeutic range (TTR_COD)

    SNOMED codeSNOMED code description

    866421000000100

    International normalised ratio time in therapeutic range expressed as percentage



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