Using mobile ECG devices to increase detection of atrial fibrillation across a range of settings in south London

Abstract

the UK have undiagnosed AF. 6 This leads to significantly increased risk of stroke, heart failure and renal disease and increases mortality when compared to those without AF. 7 With an ageing population, it is predicted that the number of people aged >55 years living with AF will more than double by 2060. 8 The UK National Screening Committee currently advises against screening for AF in the over 65s, concerned whether screening asymptomatic people has the same benefit of screening those with symptoms. 9 Guidance from the European Society of Cardiology suggests systematic screening may be considered in those over the age of 75 years or at a high risk of stroke, with opportunistic screening recommended for those over 65 years. 10 In general practice, opportunistic testing for AF was found to be more effective than routine care, and more cost-effective than systematic screening, based on the modelling for the cost of prevented strokes. 11 Despite disagreement on whether to screen for AF in asymptomatic groups, some experts advocate testing for AF, and in some areas, this may be incentivised. This project helps inform the roll out of programmes where health services choose to run them. The authors recognise that the evidence around screening for AF will become clearer after the publication of 'The SAFER-Screening for AF Study', which is due to complete in 2026 and aims to determine whether systematic AF screening in over 65-year-olds in general practice is beneficial or not. To reduce the incidence of AF-related stroke through the increased detection of AF, in 2017 NHS England commissioned the 15 Academic Health Science Networks (AHSNs) to procure 6,000 mobile electrocardiography (ECG) devices, for distribution to community settings across the county. This paper outlines the experience and learning from one AHSN, aiming to review the feasibility of using mobile ECG devices in a range of settings for opportunistic testing for asymptomatic groups at increased risk of AF. It also aims to provide insight into the effectiveness of different healthcare and non-healthcare settings at detecting possible AF. Methods The Health Innovation Network (HIN) as the AHSN for south London was responsible for the distribution of 400 mobile ECG devices across the 12 boroughs of south London. Of the ECG devices available through the project, three-quarters of devices selected by HIN were Kardia Mobile (Alivecor) a credit card sized, single-lead ECG device that uses ultrasonic signal that is received via the microphone of a compatible smartphone or tablet. The app has a built-in AF detection algorithm that provides an instant The NHS Long Term Plan aims to transform how we tackle cardiovascular disease by improving the detection and treatment of high-risk conditions. One in fi ve strokes are linked to atrial fi brillation (AF) and it is estimated that 500,000 people in the UK have undiagnosed AF. To increase detection of AF, in 2017 NHS England commissioned the Academic Health Science Networks to procure 6,000 mobile electrocardiography (ECG) devices, which were distributed to community settings across the county. The Health Innovation Network as the Academic Health Science Network for south London was responsible for the distribution of approximately 400 mobile ECG devices to a range of settings. A total of 14,835 pulse rhythm checks were performed, detecting 597 people with possible AF. This project provides insight into effectiveness of a wide range of settings in providing opportunistic testing for AF using mobile ECG devices.