Eleven AHSNs have contributed to the detection of 365 patients with undiagnosed atrial fibrillation, in one year. This means that the equivalent of one stroke per day has been prevented by this work, saving lives, reducing disability, and saving almost £8.5m to the NHS and social care.

“Late last year I was given an AliveCor portable ECG device to use in work. Since the device arrived I have used it practically every day. More patients can have the reassurance of a simple quick test, some will still need the full 12 lead ECG, but the barriers in terms of time and cost have been removed, the delay in results reporting has also gone. This device will not replace the ECG department, but it will make it quieter. The fact that the device worked first time, was easy to use and required no training meant that from the start it looked like a winner.”

GP Dr Chris Mimnagh

What was the problem?

AF imageNationally, it is estimated that nearly 1.4 million people in the UK are affected by atrial fibrillation (AF), and a quarter of these people are unaware that they have AF.

AF causes an irregular or abnormally fast heart rate. It increases the risk of stroke by up to five times, with about 12,500 strokes per year directly attributed to AF. Recognising and receiving proper treatment for AF is important because the strokes due to AF are often more severe, with a survival rate of only 50 per cent and a risk of increased disability among those who do survive, compared to those who have a non-AF related stroke. At the age of 40, we all have a one in four lifetime risk of developing AF.

What we did and why

Across the AHSN Network, diagnosis and management of AF is a major focus and an AHSN Network AF community has been formed, which aims to prevent an additional 4,500 strokes over the next five years. The charity sector is a key partner in this, as they work closely with residents who suffer from AF.

AHSN Network activity

The AF community has established interest groups on the following topics:

  • Don’t Wait to Anti-coagulate: A quality improvement programme supporting primary care, led by Yorkshire and Humber AHSN and West of England AHSN.
  • AF Landscape Tool: This provides data to influence decision makers and monitor the progress of improvement, led by Greater Manchester AHSN.
  • Detection and Diagnostics: Led by Wessex AHSN.
  • Heart Rhythm Congress: Led by Yorkshire and Humber AHSN.
  • NHS Innovation Accelerator: which is funded and run by AHSNs, has sponsored the Kardia by AliveCor AF detection device.
  • Metrics: Led by Public Health England.

Devices

There are more than 35 different digital technologies to support the identification of AF. These and other digital solutions play a significant part in the efforts to improve detection and management of AF. Devices such as Alivecor’s Kardia, WatchBP, MyDiagnostick, and Cardiocity have been used and evaluated in a variety of settings and services. These include patient-led use in hospital clinics, primary care use in consultations, screening during clinics for flu jabs and opportunistic screening in out-reach drop in clinics.

Which national priorities does this work address?

  •  Addressing the health and wellbeing gap

Results

Eleven AHSNs have contributed to the detection of 365 patients with undiagnosed AF, in one year. This means that the equivalent of one stroke per day has been prevented by this work, saving lives, reducing disability and saving almost £8.5m to the NHS and social care.

  • AliveCor is part of the NHS Innovation Accelerator, which is delivered in partnership with AHSNs. At least six AHSNs are actively supporting the use and spread of AliveCor.
  • Plessey’s ‘low-cost’ handheld device that can detect an irregular heartbeat in a home or GP setting was brought from prototype to production in less than 12 months by West of England and South West AHSNs.
  • The Innovation Agency (AHSN for the North West Coast) used MyDiagnostick and AliveCor in public facing campaigns in which 502 pulses were tested and 46 abnormal pulses detected, reducing the likelihood of stroke – saving £23,000 per person in NHS and care costs in the first year alone, ie, a potential £1 million.
  • Through the AHSN Network SBRI programme, £1.2m of funding has supported the deployment of Rapid Rhythm. The hand-held device, originating in GM AHSN, wirelessly connects to any ECG machine to diagnose AF and other major cardiac conditions, produces a clinically credible eight-lead ECG. The convenience of this device eases workflow in general practice.
  • The Innovation Agency has also supported the integration of digital technology into a commissioning tool for CCGs.

“The AliveCor device is now part of my toolkit along with my blood pressure machine and stethoscope.”

Linda Hilton, community health specialist nurse 

Next steps and spread

Continued roll-out of pulse detecting devices in new areas and with different staff groups – pharmacies, adult social care, care homes – including working with health trainers.

  • UCLPartners is launching a pan London 1000 pharmacy RCT funded by Bayer using AliveCor to detect AF in community pharmacies and testing two models of onward referral. Wessex AHSN and the Innovation Agency are running similar improvement programmes.
  • WatchBP devices detect AF and are being rolled out across general practices in Hampshire by Wessex AHSN and in Lambeth and Southwark, as part of the pan-London AF programme.
  • Yorkshire and Humber AHSN provided £11k to fund an evaluation by the York Health Economics Consortium on the use of MyDiagnostick device compared to manual pulse checks in general practices in Wakefield.
  • Cardiocity’s Safe-2-Screen trial is currently underway and takes the technology into 30 GP practices throughout England, screening 200,000 people over a 12 month period.
  • Health Innovation Network is producing an evidence review of the 35 devices for detection of AF currently on the market for our CCGs/ primary care providers.

Find out more

For more information please visit the AHSN Network website www.ahsnnetwork.com.

Learn more at the AliverCor website. www.alivecor.com.

Contact for help and advice

Dr Julia Reynolds
julia.reynolds@innovationagencynwc.nhs.uk
07852 562791

Start and end dates: 2014 – ongoing across the AHSN Network