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South London drive to detect and treat irregular heart rhythm helps prevent an estimated 100 deaths and 400 strokes

Published and last updated by Simon Ellery
Health checks in Hindu temple

Use of hand held devices to test for irregular heart rhythm in GP surgeries, care homes and religious settings is helping prevent strokes and saving lives.

The stats

Since the start of the programme, the number of additional people with AF receiving treatment each year has increased by almost 300,000 nationally.

New NHS figures reveal that a four year south London programme to improve the detection and management of an irregular heart rhythm known as Atrial Fibrillation (AF) is estimated to have helped prevent 400 strokes and saved 100 lives. These figures are based on modelling and a calculated reduction in risk.

In addition, the NHS’s Health Innovation Network in south London initiative over the last four years has reduced costs associated with strokes and deaths linked to AF by an estimated £5m and lowered social care costs by £4m.

AF is the most common type of irregular heart rhythm and is a major risk factor for stroke because it makes it more likely that blood clots will form in heart chambers and reach the brain, which contributes to 1 in 5 strokes and is associated with an increased rate of mortality. It is estimated that 1.4 million people in England have AF but nearly a third of these cases go undetected, and people with a diagnosis don’t always receive treatment, resulting in potentially avoidable strokes.

The programme consists of on-the-spot AF checks by clinicians in GP surgeries, care homes and ‘virtual clinics’ in community settings such as churches, mosques and Hindu temples using handheld devices.

Shan, aged 57 from Wimbledon and a worshipper at the Shree Ghanapathy Temple in south London, had his heart rhythm checked as part of a ‘mass screening’ earlier this year. He said:
“Today I had my blood pressure and heart rate checked. Everything is normal so I’m glad to hear that. This is a good thing so you can reduce the risk. We don’t have regular health check-ups but today we were able to see if we have anything wrong.
“My family back home and relatives have had heart attacks and diabetes. So this is also good for our peace of mind.”

AF is the most common type of irregular heart rhythm and can increase risk of stroke, leaving survivors with disabling consequences. Around 200,000 people in the UK develop AF each year. Detecting AF early and making sure people are given optimal treatment – usually blood-thinning medication to prevent clots (anticoagulants) reduces the risk of stroke by two thirds. It’s estimated that the impact of newly treating 70 high risk AF patients is up to three strokes prevented, saving the health system £37,000 in the first year.

This is part of an NHS programme, delivered by the AHSN Network in England. Nationally, this is estimated to have saved the NHS £158m and £105m in social care costs.

Since the start of the programme, the number of additional people with AF receiving treatment each year has increased by almost 300,000 nationally.

“A stroke can be devastating both physically and psychologically for patients and their families.”Oliver Brady, Programme Director for Diabetes and Mental Health at the Health Innovation Network

Oliver Brady, Programme Director for Diabetes and Mental Health at the Health Innovation Network in south London, said: “A stroke can be devastating both physically and psychologically for patients and their families. Yet with the new digital tools available we are able to detect and manage AF and ensure that fewer lives are lost and people with the condition can continue to live normal lives.
“The HIN will continue working with its local partners to proactively go into high impact settings to carry out these vital health checks.”

Professor Gary Ford, Chief Executive of Oxford Academic Health Science Network and Consultant Stroke Physician said: “Identifying people who have AF and ensuring they are provided with the most appropriate anticoagulant therapy can significantly reduce their risk of having a stroke.

“The work we have undertaken with our partners in primary care, alongside others in both the NHS and charity sector, has prevented thousands of people having a stroke. The latest data also shows that these measures have resulted in significant cost saving to the NHS and social care, with £158 million and £105 million saved respectively”

Between April and December 2018, Guy’s and St Thomas’ carried out a total of 590 pulse rhythm checks in its community podiatry clinics using Kardia devices.
GSTT community podiatrist Monica Fisk said:
“We detected 27 people with possible AF, these patients were referred on to their GP for a 12-lead ECG to confirm the diagnoses and to initiate anticoagulation treatment where indicated. The prevalence rate in our community podiatry clinics was 4.6 per cent or 1 in 22 people tested. This is higher than what is found in the general population as we tend to treat patients at higher risk of the disease. I therefore feel podiatry clinics are good settings for identifying undiagnosed AF and this opportunistic testing was well received by our patients.”

One GSTT patient said: “I never expected to attend the podiatry clinic for a foot problem and be identified as having possible AF. If it wasn’t for that appointment I don’t know what could have happened. My GP has now placed me on anticoagulation therapy and I am ever grateful to the podiatry service for going above and beyond.”

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Reports released on World Stroke Day show how to reduce the risk of strokes in south London residents

Published and last updated by Rahel Gerezgiher
remote monitoring for diabetes

Thousands of south Londoners over 65 could be at risk of a stroke because of a gap in detecting a condition that has been dubbed a ‘ticking time bomb’ by experts because of its invisible symptoms in some.

Historically, those without symptoms may not routinely receive a pulse rhythm check and it is estimated that 21,000 people across south London have undiagnosed Atrial Fibrillation (AF), an irregular heartbeat that can lead to a higher risk of stroke. But now, innovative technology and training in healthcare settings could provide a solution and save south London residents from death and disability due to a stroke.

The Health Innovation Network (HIN), the Academic Health Science Network for south London, was established by NHS England to spread health and care innovation. It is currently leading an initiative to maximise AF detection by deploying mobile ECG devices, which monitor the heart’s electrical signals, into flu vaccination clinics and care homes to identify those who need to be referred for a full assessment.

Once AF is formally diagnosed, the patient can be prescribed blood thinning medication to reduce the risk of clots forming which in turn reduces the risk of stroke by two thirds.

The HIN is upskilling existing NHS staff to use this technology to detect AF more easily, increasing workforce satisfaction and reducing hospital admissions as the system faces unprecedented strain.

Mobile ECGs were sent out to staff in various settings during the busy flu vaccination season, a time when many over-65s visit their GP. Roughly 5,000 pulse rhythm checks were taken, and from these it is estimated that 70 patients would have been found to have asymptomatic AF, which equates to roughly three prevented strokes and a £37,000 saving to the NHS in the first year.

These mobile ECG devices were also piloted in four Lambeth and Southwark care homes, where they are now being used to test for AF as part of their admissions process.

After receiving the mobile technology and training support from the HIN, one south London GP said: “[they] would definitely do it again”, a sentiment echoed among care home staff, who said: “It’s novel and the device is easy to use.”

Rod Watson, Senior Project Manager for the HIN’s Cardiovascular theme, commented “We felt that this initiative was incredibly important for this particular age group because they are most at risk of stroke, and many do not know they have AF which puts them at risk of stroke, because there are often no symptoms.

“This is about reducing the chances of this traumatic event from happening in the first place rather than treating the symptoms or, in some cases, dealing with the devastating consequences.

 “Working closely with our NHS partners in flu vaccination clinics and care homes, we could target the ‘at risk’ demographic and help save lives with a very simple mobile detection programme.”

For further information, get in touch at hin.southlondon@nhs.net

“This is about reducing the chances of this traumatic event from happening in the first place rather than treating the symptoms or, in some cases, dealing with the devastating consequences.”

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A tale of my grandfathers and the revolution in cardiovascular disease prevention

Published and last updated by Rita Mogaiji

A tale of my grandfathers and the revolution in cardiovascular disease prevention

Laura Semple, Programme Director for Diabetes & Stroke Prevention at Health Innovation Network, reflects on how new prevention techniques might have changed her grandparents’ lives.

I’ve often wished I’d had the chance to meet my grandfathers, Gerry and David. They were both fascinating and spirited people, who led interesting lives. Gerry travelled the world, had a successful career in industry and loved fishing for trout in the Welsh countryside. David worked in finance for London Transport and enjoyed vintage cars.

Sadly, I didn’t get to meet them because, like many people of their generation, they died too soon from cardiovascular disease in the 1970s and early 1980s.

This part of my family history is far from unique. It’s also a big reason why I find it so rewarding to be part of the movement of committed people working to prevent cardiovascular deaths in this country. February is National Heart Month and I’m thoughtful about the real progress that we’re seeing in south London in this area.

One of the main drivers of cardiovascular disease in the UK that Gerry and David grew up in was a lack of understanding around the impact of certain foods and other lifestyle aspects on heart health. It was very common to eat a high fat diet and the true scale of tobacco-related harm was not yet understood. But since the 1970s we have gained a rich understanding of the impacts of diet, exercise, tobacco and medication on heart health.

What’s more, we now have risk models, which enable us to accurately predict how likely it is that someone will have a heart attack or stroke in the next 10 years, simply by knowing their BMI, blood pressure, cholesterol and blood glucose measurements today.

This all makes me wonder just how different it could have been for Gerry and David. Not only are we now able to offer preventative care that extends lives, but crucially these are also improving the quality of those lives.

At its core, most of our work is really about giving Londoners the support they need to live full lives without the burden of diabetes and cardiovascular disease.

The first success to highlight on the prevention front is south London’s contribution to the Academic Health Science Network’s national stroke prevention programme.

Atrial Fibrillation (AF) is one of the most common types of irregular heart rhythm and contributes to one in five strokes. If Gerry and David had been born 20 years later, there’s a good chance that they could have been two of the more than 4,500 additional south Londoners whose AF has been newly detected since 2017.

The latest national stroke audit data shows that in the two years to March 2019 there were approximately 150 fewer AF-related strokes in south London than would have been expected from the previous years’ data. This is 150 Gerrys, Davids, Simones, Ritas, Mohammeds, and many others, who are still thriving as a result. We’ve recently published the results of our innovative work in improving AF detection through mobile ECG devices here and an ongoing pilot of 14-day ECG patches on page 12 of Cardiac Rhythm News January 2020 here.

Then there’s diabetes.

This is a major driver of cardiovascular disease and it’s simply astonishing how much our experience and understanding has transformed since Gerry and David were alive. Back in the 1960s and 1970s, we were not as good at detecting type 2 diabetes, so some people lived with the condition for many years without a diagnosis, which in itself increased their risk of preventable ill health.

In general, there was far less freedom and choice for people with diabetes in how they lived their lives, with many being told to stick to rigid set diets.

But in 2020, we believe in giving people with diabetes as much freedom as possible to live the lives they want, without diabetes getting in the way. South London has a formidable partnership of colleagues committed to minimising the impact of diabetes on citizens’ lives. Together we represent 12 clinical commissioning groups, 12 local authorities, seven acute hospitals, two universities, the King’s Health Partners Institute of Diabetes, Endocrinology and Obesity, the Applied Research Collaborative, several industry partners and community organisations like the Wandsworth Community Empowerment Network The last two years has seen a major focus on type 2 diabetes prevention, with over 30,000 south Londoners referred to the NHS.

I’m curious as to what Gerry, David and their friends might have chosen if they had had access to Diabetes Book & Learn, a radical move to scrap the previous postcode lottery of self-management support for people with diabetes. In this new system, south Londoners are learning how to live well with diabetes at a time and place that works for them in their busy lives, with different languages, digital options, evening and weekend courses and telephone coaching all available.

Would Gerry and David’s employers have supported their access to diabetes education through the learnings of our Think Diabetes report?

People with type 2 diabetes are also increasingly taking charge and setting the agenda for their doctors and nurses in the innovative You & Type 2 programme in primary care.

Would Gerry and David’s employers have supported their access to diabetes education through the learnings of our Think Diabetes report? This was supported by former Labour Party deputy leader Tom Watson. Many forward-thinking employers are using the recommendations in this report to offer support directly in the workplace.

At its core, most of our work is really about giving Londoners the support they need to live full lives without the burden of diabetes and cardiovascular disease. Healthy living is far from easy. People need holistic and non-judgemental support and this is why the offer of psychological support is built into Diabetes Book & Learn and many other new services.

There is a great deal more to do to prevent cardiovascular disease and exciting plans are afoot to do even more to tackle the longstanding health inequalities in our region. For now, I’m asking everyone who has played a role in the great progress so far to take a moment this heart month to remember the strides we have made together and renew our energy to take this to the next level.

If you are keen to join the fantastic team of people saving lives by preventing cardiovascular disease in south London please visit our webpages on diabetes and cardiovascular.  Alternatively, get in touch with me on laurasemple@nhs.net. This year we will be focussing on cholesterol and blood pressure as well as continuing to support our members with AF detection and improvements in diabetes care. The more collaborators we have, the more lives we can save.

I know that Gerry and David would be only too happy to see that things are different and getting even better, for the generations who came after them.

Contact Laura Semple

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NB: Gerry and David are not the grandfathers’ real names.

Over 3,000 strokes prevented and 800 lives saved through national drive to detect and treat irregular heart rhythm

Published and last updated by Rahel Gerezgiher

Over 3,000 strokes prevented and 800 lives saved through national drive to detect and treat irregular heart rhythm

Recently released figures reveal that a programme rolled out across the NHS to reduce strokes related to an irregular heart rhythm prevented 3,165 strokes and 791 lives last year (2018/19). 

The NHS initiative focussed on improving the detection and treatment of Atrial Fibrillation (AF) – the most common type of irregular heart rhythm that can increase risk of stroke. In the UK, one million people are known to be affected by AF and an additional 422,600 people are undiagnosed. This irregular heart rhythm is responsible for approximately 20% of all strokes, which can leave survivors with disabling consequences. Treating the condition costs the NHS over £2.2 billion each year. 

Making sure people with AF are given optimal treatment – usually blood-thinning medication to prevent clots (anticoagulants) – can more than halve their risk of having a stroke. 

AHSNs have played a key role in this nationwide initiative. Pulse checks for over 65’s, mobile ECG devices for GP surgeries and pharmacies, and new ‘virtual clinics’ involving specialists working with GPs to advise on the best treatment for people with the condition, were amongst the varied activities undertaken as part of this life saving work. 

As a result, last year over 61,000 people were diagnosed with AF for the first time and almost 80,000, including some who were previously diagnosed, were given appropriate medication. 

Professor Gary Ford, Chief Executive of Oxford Academic Health Science Network and Consultant Stroke Physician said “Spotting the risk of stroke early and taking preventative measures can help to reduce risk of premature death and reduce the number of people who experience life-changing, long-term disability due to stroke. Identifying people who have AF and ensuring they are provided with the most appropriate anticoagulant (blood thinning) therapy can more than halve their risk of having a stroke.

“Since 2016 AHSNs have worked tirelessly with others across the healthcare system to reduce the burden of stroke. This recently released data illustrates the significant impact our work has made, improving lives and reducing cost to the NHS.”

What has stroke prevention in south London looked like? 

During the 2018-19 financial year, the Health Innovation Network’s Stroke Prevention in Atrial Fibrillation programme achieved success in improving the detection and treatment of AF in south London through the spread and adoption of digital innovation in high-impact settings.  

The team’s Mobile ECG Devices Project  report, released in September 2019, describes how from January 2018 to March 2019 a total of 400 mobile ECG devices—Kardia Mobile, WatchBP and MyDiagnostick—were distributed across the 12 south London boroughs, resulting in the recording of 14,835 pulse rhythm checks and the detection of nearly 600 possible cases of AF, potentially preventing 23 strokes with estimated savings of £309,000 to health services.  

AF checks in the identified high impact settings – flu vaccination clinics, community podiatry clinics and all three mental health trusts – are now in active implementation. This significant progress falls in line with the data collected since 2015, which shows that the number of strokes caused by known AF in south London has significantly reduced. The latest national stroke audit data has now been published and shows that in the two-year period from April 2017-March 2019 there were approximately 150 fewer AF-related strokes in South London than would have been expected from the previous years’ data. This is particularly impressive in the context of the increasing population age. 

HIN’s AF team is continuing to support these high-impact settings and we would be delighted to hear from member organisations interested in getting involved in this life-saving work.

Contact HIN AF Project Manager Alex Lang

AHSNs win AF Association Healthcare Pioneer Awards

Published and last updated by Rahel Gerezgiher

The AHSN Network Atrial Fibrillation (AF) programme and six regional AHSN partner AF projects have received AF Association Healthcare Pioneer awards for best practice in AF detection and treatment.

The AF Association is a UK charity that focuses on raising awareness of AF by providing information and support materials for patients and medical professionals involved in detecting, diagnosing and managing AF. Each year, the AF Association Healthcare Pioneer awards recognise those who demonstrate excellent clinical practice and the development of AF services to improve patient outcomes and quality of life.

AHSNs projects were amongst the 17 winners at the 2019 awards. Regional projects recognised included:

  • East Midlands AHSN, for work in partnership with East Midlands Clinical Network and 19 Clinical Commissioning Groups, preventing an estimated 167 strokes, 56 deaths, secure health and care cost efficiencies of £3.45million per year.
  • Health Innovation Manchester, for supporting NHS Tameside and Glossop CCG, facilitating pharmacy-led clinical reviews in 38 GP practices to detect and optimise treatment for those with AF.
  • Health Innovation Network, for supporting Guys and St Thomas NHS Foundation Trust to trial mobile ECG devices. These were used in in community clinics, domiciliary settings and at awareness events. Opportunistic testing was also conducted by community podiatrists.
  • Oxford AHSN, for working with Buckinghamshire CCG to improve therapy for a patient cohort with complex needs that had not been met by existing anticoagulation pathways.
  • UCLPartners, for work with South East Essex CCGs, issuing mobile ECG devices to 82 per cent of practices across the CCGs, resulting in 23 new patients identified with possible AF and 431 additional patients receiving anticoagulation treatment.
  • Eastern AHSN, for work with The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust, providing mobile ECG devices which contributed to 49 patients newly diagnosed with AF and 44 patients started on anticoagulation therapy.

The awards took place during the AF Association Global AF Aware Week Parliamentary Event, held within the Palace of Westminster.

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