NICE guidance for self-monitoring
Published by Mark Hill on Wednesday, September 24, 2014
NICE has recommended the CoaguChek XS system and the INRatio2 PT/INR monitor (devices known as coagulometers) on the NHS for adults and children with atrial fibrillation or heart valve disease if the person prefers this form of testing and the person or their carer is both physically and cognitively able to self-monitor effectively.
The self-monitoring devices measure international normalised ratio (INR), which is the time it takes for blood to clot. Patients on oral anti-clotting medication, such as warfarin, are at increased risk of complications such as blood clots or excessive bleeding if their INR level is not regulated properly. There are currently more than 1.2 million people in the UK on warfarin, of whom less than two per cent benefit from self-monitoring despite evidence that it can cut the risk of death by nearly two-fifths and more than halve the risk of strokes.
The NICE guidance comes only a week after the Government published it response to a House of Commons Health Select Committee report into the management of long-term conditions, stressing the importance of self-management and noting that better use of technology in the NHS can empower patients, improve communication between services and deliver efficiencies and savings for the NHS.
Unfortunately, not everyone on long-term warfarin is expected to get access to the devices. The Anticoagulation Self Monitoring Alliance recently produced a report which revealed that two-thirds of Clinical Commissioning Groups (CCG) in England do not allow or support INR self-monitoring in their area. This means that the vast majority of people on long-term warfarin are being denied the opportunity to self-monitor, despite the benefits to the patient in terms of health outcomes, convenience and quality of life, and the long-term cost savings to the health service.
Let’s hope CCGs look at the guidance closely and incorporate its recommendations into their anticoagulation service at the earliest opportunity, so that the benefits of self-monitoring can be offered to as many people as possible.