Detecting atrial fibrillation

A credit card-sized device that works through an app on smart phones and tablets to capture a near-medical grade echo cardiograph (ECG) in 30 seconds.

The result is summarised as ‘normal’, ‘unreadable’, or ‘likely atrial fibrillation’ (AF). The device, which costs about £100, is being used in pharmacies by pharmacy assistants - they offer customers who fit the correct profile a ‘free NHS heart check’.

How was it developed

The technology has been developed by AliveCor, but its use in the UK has been developed by Care City, formerly part of North East London NHS Foundation Trust (NELFT) but now registered as a community interest company, alongside some other innovators across the NHS. Having seen the product marketed to individuals in the US, Care City explored how it could be best used in the NHS.

The three-step development involved first testing the technology, then testing it in a single service, and then across a care pathway. Conversations with health care staff, leaders and patients contributed to the work.

Trialling took place in a GP surgery and in pharmacies, with the testing being done by pharmacy assistants as they had the most customer-facing role in the pharmacy. When a result indicated AF, the person was referred to their GP. The testing found about as many people as expected (7 per cent) with the condition.

Feedback from GPs questioned whether it was necessary to refer back to GPs the people who appeared to need onward referral. A workshop with all partners involved considered what a good pathway for someone with AF would look like. The outcome was to enable the testing pharmacies to share the person’s ECG with the hospital (Barts Health NHS Trust) for triage. The hospital would then invite people for appointments if necessary. The next step was for Barts to set up a one-stop AF clinic, where the results from the pharmacy-taken ECG would help to save time.

Outcomes

An NHS Innovation Accelerator report states: “AliveCor’s Kardia is a digital application with convincing evidence of its ability to yield valuable diagnostic information when used in a primary care setting. However, there are many ways it can be used within existing care settings. [Examples] demonstrate the adaptions required for it to be successfully embedded within GP practice and pharmacy settings. Furthermore, when an intervention is found to accelerate detection, redesign of the care pathway may also be needed to ensure newly diagnosed patients can rapidly access appropriate treatment.”

Care City says the pathway that resulted from the adoption of the technology has been witnessed as effective in to screening people for AF and has reduced screening to treatment time from 12 weeks to 2-3 weeks. An independent evaluation by University College Hospital is underway and at the time of writing (June 2019) the pathway was about to be commissioned across three London boroughs.