Evaluating the use of a mobile device for detection of atrial fibrillation in primary care
Dear Sirs,
We read with great interest the article written by Highton and colleagues that was published recently in your journal.1 They presented their findings from the East Midlands AF Advance Programme – a service improvement evaluation targeted at improving the diagnosis of atrial fibrillation (AF) in primary care settings in the East Midlands. The authors focused on three areas in their initiative: practice audit and care improvement; clinician upskilling; and AF diagnosis using mobile AF detection devices. Subsequently, they have found an increase in AF prevalence and anticoagulation prescription rates across the East Midlands. We congratulate the authors for their article and wish to make some further contributions from our parallel work across Staffordshire.
Our initiative in Staffordshire ran between April 2018 and March 2020 and found similar outcomes within our patient population. The six Staffordshire Clinical Commissioning Groups (CCGs) cover a population of circa 1.2 million. A multi-pronged initiative based on the adoption of mobile electrocardiogram (ECG) devices (AliveCor KardiaMobile 1 lead) at scale, supported by a series of educational workshops and recruitment of local AF clinical champions to offer on-the-ground leadership, was undertaken across Staffordshire.
Quantitative data were then collected from the Quality Outcomes Framework (QOF) indicators for each practice.2 User feedback was also collected from the recipients of AliveCor devices using an online survey package (SurveyMonkey).
There were 312 AliveCor devices distributed to clinicians from 113 general practices across Staffordshire in this timeframe. Seven clinical AF champions, one practice manager AF champion and one AF exemplar practice contributed to local educational resources, led their practice teams, and promoted the use of AliveCor devices within the region. AF prevalence rates increased from 2.00–2.50 in 2017/18 for all six CCGs to 2.16–2.78 in 2019/20, compared with a rise from 1.91 to 2.05 in national AF prevalence rates in that time period.2
The e-survey was completed by 61/312 recipients of the AliveCor devices: 92% found the device useful and 97% would recommend the device to another colleague. The device was used during consultations with symptomatic patients or after palpating an irregular pulse on examination by 65%. The remaining use was for opportunistic or targeted screening, e.g. as part of ‘flu clinics, nursing home ward rounds or long-term condition reviews in elderly patients or those with a history of heart disease.
We agree with Highton et al.1 that mobile AF detection devices, such as the AliveCor Kardia Mobile 1 lead device, provide a practical alternative to traditional ECGs and should be incorporated into routine clinical practice for opportunistic AF detection – and this could and should be expanded to all healthcare settings. The data from both the initiatives lend further real-life evidence to existing literature that these initiatives can indeed improve clinical outcomes and are doable with appropriate screening devices and educational support for clinicians.
Conflicts of interest
Dr Ruth Chambers’ engagement with the project was partly funded from the joint working project; Dr Mathew was not.
Funding
Funding for this project was from funds allotted to Staffordshire by NHS England’s Estates and Technology Transformation Fund, and Bristol Myers Squibb (BMS) & Pfizer and Daiichi Sankyo UK (DSUK) as non-promotional joint working projects. BMS & Pfizer, and DSUK, had no input or influence over the design and rollout of the programme nor content of this report.
Study approval
This was a service redesign programme where screening for AF via the NICE approved AliveCor Kardia Mobile device was undertaken as usual service, and thus did not require medical ethics approval or specific patient consent over and above patient implied consent for usual delivery of primary care.
Limitations
The major limitations with our initiative like those in the AF Advance Programme are the lack of control groups, limited patient level data and limited control over variables due to the dynamic nature of the clinical setting.
Savio Mathew
Clinical Teaching Fellow
Leicester Medical School, Lancaster Road, LE1 7HA
Ruth Chambers
Staffordshire STP’s Clinical Lead for Technology Enabled Care Services Programme, Digital Workstream, and Honorary Professor, Keele University, and Visiting Professor, Staffordshire University
c/o Stoke-on-Trent Clinical Commissioning Group, One Smithfield Leonard Coates Way, Hanley, Stoke-on-Trent, ST1 4FA
([email protected])
References
1. Highton PJ, Mistri A, Ng A, Glover K, Khunti K, Seidu S. Evaluating the use of a mobile device for detection of atrial fibrillation in primary care. Br J Cardiol 2021;28:11–3. https://doi.org/10.5837/bjc.2021.005
2. NHS Digital. Quality and Outcomes Framework, 2019–20. London: NHS, 2020. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/quality-and-outcomes-framework-achievement-prevalence-and-exceptions-data/2019-20
