Hippo Labs uses the official NHS England QOF Business Rules to help practices manage atrial fibrillation (AF) care systematically — from maintaining an accurate register to ensuring appropriate stroke-risk assessment and anticoagulation.
💬 Just a reminder: these indicators aren’t clinical guidelines — they’re operational definitions used for QOF measurement. They determine which patients appear for recall, how achievement is calculated, and where gaps may occur.
📋 The Atrial Fibrillation Register (AF001)
The AF register forms the foundation for all AF indicators. It includes patients with an ongoing diagnosis of atrial fibrillation who require annual review and stroke-risk assessment.
Patients appear on the register if they:
Have a diagnosis of atrial fibrillation, and
Do not have an AF resolved code.
✅ In short: all patients with an active AF diagnosis should appear on the register.
🩺 The Indicators
These indicators apply only to patients on the AF register. Together, they measure how effectively the practice identifies and manages stroke risk through structured assessment and anticoagulation.
🧮 AF006 — Stroke-Risk Assessment
Measures:
% of patients with AF who have had a CHA₂DS₂-VASc score recorded in the last 12 months, excluding those who already have a score of 2 or more from a previous assessment.
Counts as complete if:
A CHA₂DS₂-VASc score is recorded within the past 12 months.
Exclusions (Personalised Care Adjustments):
Unsuitable for review (e.g. clinical reason recorded)
Declined AF review or care
Two coded invitations ≥7 days apart with no attendance (removed for payment only — Hippo continues to flag for recall)
Newly diagnosed within the last 3 months
Newly registered within the last 3 months
⚠️ Common pitfalls:
Using CHADS₂ instead of CHA₂DS₂-VASc (only the latter counts now)
Missing the score value when entering the code
Recording the assessment without a date or numerical value
Relying on old scores — must be updated annually
✅ In short: all AF patients with previous scores under 2 should have a CHA₂DS₂-VASc assessment coded within the last 12 months.
💊 AF008 — Anticoagulation Therapy
Measures:
% of patients on the AF register with a CHA₂DS₂-VASc score ≥2 who are:
Prescribed a Direct-acting Oral Anticoagulant (DOAC), or
Where a DOAC was declined or clinically unsuitable, prescribed a Vitamin K antagonist (e.g. warfarin).
Counts as complete if:
Patient with CHA₂DS₂-VASc ≥ 2 has:
A DOAC prescription in the last 6 months, or
A Vitamin K antagonist prescription in the last 6 months and one of the following applies:
DOAC declined or contraindicated
Antiphospholipid syndrome
DOAC not indicated (and recent TTR ≥ 65%)
Or, the patient has a mechanical valve and is on a Vitamin K antagonist.
Exclusions (Personalised Care Adjustments):
Contraindication or decline for all anticoagulants
Mechanical-valve patients contraindicated to warfarin
Newly diagnosed or registered within 3 months
Two coded invites ≥7 days apart with no attendance (removed for payment only)
⚠️ Common pitfalls:
Not recording contraindication or decline codes — leaving apparent gaps in care
Missing TTR value for patients on warfarin
DOAC prescribed outside the 6-month timeframe
Confusing antiplatelet therapy with anticoagulation (does not count)
✅ In short: every AF patient with CHA₂DS₂-VASc ≥ 2 should either be on a DOAC or, if unsuitable, a Vitamin K antagonist — with the reason clearly coded.
🧩 Putting It All Together
Indicator | Focus | What It Shows | What to Do |
AF006 | Stroke-risk assessment | Whether CHA₂DS₂-VASc scoring is up-to-date | Review and record CHA₂DS₂-VASc annually |
AF008 | Anticoagulation | Whether high-risk AF patients are protected against stroke | Prescribe and code DOAC or warfarin (or record reason not indicated) |
🌟 Why This Matters
Following these indicators helps practices:
Maintain a validated register of AF patients
Ensure consistent, evidence-based stroke-risk assessment
Improve anticoagulation coverage for high-risk patients
Demonstrate QOF compliance and safer long-term management
✅ In short: the AF indicators ensure accurate registers, consistent risk assessment, and effective anticoagulation for every eligible patient.
📚 Sources
NHS England QOF Business Rules v50.0 (Atrial Fibrillation, April 2025)
Primary Care Domain Reference Sets (TRUD Portal)