Evaluation of atrial fibrillation detection in primary care settings across south east London

Background  

Atrial Fibrillation (AF) is a common heart rhythm condition affecting around 1.4 million people in the UK. However, many people are living with the condition without knowing it. Undiagnosed AF can lead to serious health consequences if left undetected and untreated.

This report presents findings from a pilot project testing the use of a handheld device, MyDiagnostick, for detecting AF in primary care settings. The objectives of this evaluation were to:

• Understand the impact of the project on AF detection, including reach and demographic breakdown (age and gender) of participating patients.
• Understand the experiences of primary care clinicians involved in the project.
• Identify what worked well in delivery, and why.
• Highlight challenges and learning from implementation.

Project overview

A total of 247 MyDiagnostick devices were distributed to almost all primary care practices and some community sites across the six boroughs of south east London. Significant delays were experienced during this phase due to the time required to complete the Data Protection Impact Assessment (DPIA), a national shortage of devices, and staff turnover within the project team. In most cases, project sites did not receive their device until seven months after the initial launch webinar.

Four online education and training webinars and two Communities of Practice sessions were delivered throughout the project. These covered topics such as AF detection, the patient pathway, AF management and treatment options, along with an instructional webinar on how to use the MyDiagnostick device.

Project outputs

Across 51 sites, 864 patient assessments were recorded using the MyDiagnostick device. Of these, 42 (4.9%) registered an abnormal heart rhythm. Among those 42 patients, 9 (21.4%) were referred for further investigation with a 12-lead ECG. At least two of those patients were subsequently diagnosed with AF and at least one of them started taking anticoagulant treatment.

Forty-nine healthcare professionals (HCPs) involved in the project were invited to complete online questionnaire, with 10 responses received (20.4%). Three HCPs also took part in a follow up focus group to explore some of the issues further. HCPs reported confidence in using the device, good understanding of the patient pathway, and positive patient feedback – with patients appreciating both the AF check and the simplicity of the device.

Challenges mainly related to the delay from project launch to receipt of the device, IT issues, and the difficulty of embedding the device into routine practice. Despite these challenges, the project was considered acceptable and feasible by some HCPs in primary care settings.