Application of the UK NHS Improvement Anticoagulation Commissioning Support Document for 'safety indicators' in atrial fibrillation. Results of the European Action on Anticoagulation study.

Introduction 'Safety indicators' in the anticoagulant management of atrial fibrillation (AF) are listed in the UK NHS Improvement Document, 'Anticoagulation for AF', aiming to promote quality services. Acceptable clinical event rates are not quantified in the document. Objective To provide clinical evaluation of the relevant safety indicators using data from a recent large European Action on Anticoagulation (EAA) study. Results 469 clinical events were recorded in 5839 outpatients in the EAA study. The safety indicators listed in the NHS Improvement Document were related to these patients with AF. The relevance of the 'safety indicators' is confirmed by the EAA study for patients starting oral anticoagulation and for those already receiving oral anticoagulation, and quantified. Conclusion The EAA clinical study provides a quantitative basis for the safety indicators' in AF listed in the NHS Commissioning Support Document and emphasises the importance of the document.