A performance-related financial incentive scheme for general practitioners in the U.K. led to a nearly five-fold increase in the number of heart patients doctors said had been “cured” of atrial fibrillation, according to a recent analysis.
The study, spearheaded by research fellow Nicola Adderley, MA, PhD, MPH, and colleagues at the University of Birmingham, evaluated the consequences of the Quality and Outcomes Framework (QOF), a performance management and payment system introduced in 2004 to improve the quality of general practice and solve GP shortages in the U.K. QOF requires GPs to keep a register of patients with chronic disease—including atrial fibrillation—and physicians are paid an incentive to ensure that a certain percentage of their AFib patients receive drugs for stroke prevention. “Resolved” AFib patients, however, aren’t included in the register.
Arrhythmias greatly raise a heart patient’s risk of suffering a stroke, and for that reason most AFib patients are prescribed anticoagulants to mitigate their risk. But previous work from Adderley and her colleagues found that even after they’re marked as “cured” by their GPs, many AFib patients remain at a high risk of stroke and should stay on blood thinners.
For their present study, Adderley et al. reviewed the GP records of 250,788 AFib patients between 2000 and 2016. Of that total, around 6%, or 14,575 patients, were recorded as having “cured” or “resolved” atrial fibrillation.
The researchers found that prior to 2005—before the QOF was introduced—resolved cases of AFib were relatively uncommon in their dataset. They became almost five times more common after the QOF was revised in 2006 to include specific performance targets for AFib management. The proportion of resolved AFib cases rose dramatically from 5.7 per 1,000 person-years in 2005 to 26.3 per 1,000 person-years in 2006, and it’s continued to grow.
“It is possible that this increase was, in part, the result of GP practices catching up with recording ‘resolved’ atrial fibrillation following the introduction of QOF,” Adderley said in a release. “However, we know from our previous research that the vast majority of patients with resolved atrial fibrillation do not receive stroke prevention drugs.
“Our latest study gives evidence that, since the introduction of these performance targets, patients with atrial fibrillation are deemed to be cured simply because they aren’t being prescribed anticoagulants.”
The authors said their past work has proven that AFib can never be considered truly resolved, since it’s a condition that can resurface at any point in a patient’s life. They reported that the increase in resolved cases of AFib were steepest between January and March, just before performance targets were measured in April.
“Prior to 2006, resolved cases of atrial fibrillation were recorded throughout the year with little monthly variation in incidence,” co-author Tom Marshall said in the release. “The effect of this is that GPs’ performance appears improved, which can be equated to getting troublesome children to stay at home on the day of a school inspection.”
The team said they hope their results will lead to changes in the QOF rules that allow AFib patients to remain on their doctors’ chronic disease registry even if their condition is marked as resolved. It’s easy for those “cured” patients to fall off their GPs’ radar, the authors said, and that reduced attention can result in poorer health outcomes.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.