Grasp-AF

Atrial Fibrillation (AF) is an irregularity of the pulse.
Having this irregular pulse puts the patient at an increased risk of having a stroke.
This risk can be reduced by taking aspirin or warfarin.
The risk of having a stroke increases with age so we tend to recommend warfarin for the older folk with AF.


So what is the risk?


If you are less than 65 with an otherwise healthy heart then the annual risk of stroke is about 1%
If you are between 65 and 75 that risk increases to 3% especially in those with diabetes or known vascular disease
Over 75 or anyone with a damaged heart valve or a previous stroke, the risk is nearer 6%



Imagine 1000 people at 1% risk of having a stroke each year.
Without treatment about 10 of them will have a stroke.
So 990 of them will not have a stroke. 



However, if those same 1000 people each take low dose aspirin, over a year:

• About 2 people will be ‘saved’ from having a stroke by taking aspirin
• About 8 people will still have a stroke, even though they take aspirin.




If we look at the 6% risk category in 1000 people it is likely that about 60 would have a stroke.



If those same 1000 people each take low dose aspirin, over a year: 


• About 12 people will be ‘saved’ from having a stroke by taking aspirin
• About 48 people will still have a stroke, even though they take aspirin. 


So aspirin seems more efficient the higher the risk.


Warfarin is better still and in this same higher risk group being on warfarin 36 people a year would not have a stroke because of being on warfarin; and only 24 would have a stroke even though they were on warfarin.


Statistically about 3 of those 1000 people in that year might have a serious haemorrhage because they were on warfarin. But it would save 21 more strokes than the aspirin, so in the end the benefits statistically outweigh the risks.


There is a document here called a "Patient Decision Aid"


This shows those same figures somewhat more graphically.
It is funny but when you look at the picture of 1000 people and who might have a stroke it seems to be to reduce the impact of the risk of a stroke.
BUT you just can't tell which patients are the ones that will be the ones to have a stroke.


We are moving now to attempting to identify more people with irregular pulses and will then try to decide individually with them whether to recommend taking aspirin or warfarin to reduce the risk of stroke.


We have something like 250-300 patients on our list with AF. I haven't sat down and risk assessed them individually but we must be looking at a potential half-dozen strokes a year without aspirin or warfarin, so that may translate into a couple of strokes a year avoided if we had the majority of patients on preventive treatment.

New carers' support service launched in Devon

Carers in Devon can now find out about support and information from one place for the first time, as part of a £1.3 million investment by Devon County Council and NHS Devon.

As part of the new Devon Carers Centre a new telephone helpline has been launched to give carers better access to support to help them stay healthy and live a normal life outside of caring.

Carers will be able to access the following services through the helpline:

• Support and information at the ‘first stop’ from the helpline advisor
• A network of local carers’ support workers who provide face to face support and activities for young carers to enjoy being young people
• Opportunities to meet other carers in their area for mutual support, friendship and time away from caring
• Short carers breaks

The new helpline (08456 434 435) is open from 8am to 6pm Monday to Friday and on Saturdays from 9am to 1pm.

The helpline is run by voluntary organisation Westbank, working closely with other carers’ voluntary groups, who will also provide support in their local area. A website has been launched at www.devoncarerscentre.org.uk/

Self referral for mood disorders

I had news this week that our patients are now able to self-refer for psychological treatment of anxiety and depression. The self-referral system for physiotherapy has been very helpful so extending into mental health areas should be too.
If you wanted just a quick reference on helping yourself they have a leaflet you can download here.


I've lifted a few bits from their leaflet to post here.
It doesn't really make it clear here that if you are already undergoing treatment with the mental health services then self-referral isn't appropriate.
They also would prefer that if you are low or anxious during pregnancy and seeking help that you go to your GP initially.
Common sense suggests that if you are significantly ill with mental health problems then this route of referral would not be appropriate initially either.
Veterans and those with a complex history of childhood abuse should really start with their GP also.




The Depression and Anxiety service is a primary care service delivering evidenced based psychological interventions in line with NICE guidance.
These include Cognitive Behavioural Therapy (CBT), Eye Movement, Desensitisation and Reprocessing (EMDR) and Applied Relaxation.
Psychological interventions take place both in a group setting and via individual sessions.




The service is for people in the South and West of Devon who are 18 years and over.


Our team is able to help you with the following:
• Panic attacks
• Depression
• Anxiety
• Excessive worry
• Social anxiety/shyness
• Phobias
• Post traumatic stress disorder
• Agoraphobia




Your GP can refer you or you can refer yourself and we will let your GP know.
You can refer yourself by phoning 01626 357260.
Outside of office hours there is an answerphone. Please leave your name and contact details and we will phone you back.
You can email on:  tr.southandwestdevondas@nhs.net


We will talk to you about your difficulties and agree with you the best way forward.
We can refer you on to other services and give you telephone numbers of alternative treatment options.


We aim to see everyone within four weeks of referral and the initial appointment will take approximately 30 - 40 minutes.






We will look at treatment options with you which are based on Cognitive Behavioural Therapy (CBT).
This looks at the way that thoughts, feelings and behaviours interact, sometimes in a helpful, and sometimes in an unhelpful way.


We provide a choice of help that includes:
• Working with you to identify the difficulty you are having
•  Help you in deciding where to start
•  Recommending reading that would be helpful for you
•  Providing information about other local resources that might be helpful for you
•  Identifying thoughts and actions which may be unhelpful for you
•  Identifying strengths and support to draw on
•  Guidance in setting realistic goals and support in achieving them
•  Providing support through self management programmes that have proven to be effective
•  Group work and/or individual therapy.


We also offer Eye Movement Desensitisation and Reprocessing (EMDR).
This is a specific treatment for people who have experienced a trauma.