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

Digital is helping us tackle healthcare inequalities, but the real issues are deeper and run system-wide

Alex Lang describes the benefits of mobile ECG devices for people with serious mental health conditions and their potential to help tackle health inequalities.

It is a sobering fact that people with a serious mental illness have a life expectancy 15-20 years less than the general population.

The reasons vary, but the higher rates of cardiovascular disease experienced by this part of our population are a large part of the problem. According to Public Health England data, people with a serious mental illness aged 15-74 are nearly twice as likely to suffer a stroke as the general population. Part of the reason is that hypertension, diabetes, smoking and alcohol use are key risk factors for stroke and are all greater in those with a serious mental illness.

The medications used to treat serious mental illness complicate the picture further. Some can cause weight gain and obesity, which further increases risk of stroke. Others are associated with electrocardiogram (ECG) changes, and it is possible that certain drugs are causally linked to serious ventricular arrhythmias and sudden cardiac death.

When we started rolling out mobile digital devices to help detect stroke risk, the stark inequality made it was obvious that we needed to prioritise working with our mental health colleagues across south London. In a mental health setting, mobile ECGs can help not only by detecting atrial fibrillation, an irregular heart rhythm associated with stroke, and helping to diagnose and treat people at higher stroke risk. They can also make it easier to offer people ECGs before they start medications when needed.

The mobile ECG we are rolling out, called Kardia Mobile, is a credit card sized, single lead rhythm strip linked to an app on tablet or smart phone, that works by the user placing their fingers on it for 30 seconds. Compare this to a 12 lead ECG: it’s invasive for patients and harder for staff. Traditional 12 lead ECGs aren’t always easy to access either, particularly if a patient is acutely unwell or housebound. This is a serious issue – as patients could start medication that increases their cardiac risk without the appropriate monitoring in place.

These digital devices are starting to make a real difference. One of our partners, Oxleas NHS Trust, a mental health trust in southeast London, is already using Kardia Mobile ECG devices in clinical practice. Already, this is allowing staff to increase the numbers of opportunistic pulse rhythm checks they perform to identify service users with undiagnosed atrial fibrillation. These checks enable timely detection, diagnosis for AF, and treatment with anticoagulants which can reduce risk of stroke by two thirds.

Oxleas is also using the Kardia mobile ECG device for service users where a 12 lead ECG is declined or not practically possible. Kardia is designed to indicate whether AF is present, but by using an on-line calculator, clinicians can calculate the QTc reading from the trace, so that medication can be prescribed safely. This can then be followed up with a 12 lead ECG once practically possible.

This is just one example where digital devices and innovations can make a real difference in mental health care. There are countless others, and we’ll be exploring the potential of digital innovation and its potential to help prevention, self-management and efficient and safer care at our upcoming event in January.

We’re focusing on the potential of digital in mental health because too often, mental health provision has lagged behind, while physical health care has received the lion’s share of attention and funding. This is changing, but it’s crucial that mental health settings reap just as many of the benefits of digital innovation as other healthcare settings.

Digital devices alone won’t change the shocking discrepancy in life expectancy. To really close this health inequality gap, the entire health and care system must make a much greater cultural shift. But we believe that innovation has a role to play in that shift and we’re committed to working with our partners to use innovation to improve care for people with serious mental illness, and to reduce wider health inequalities.

To find out more, please contact Alex Lang, Project Manager in Stroke Prevention alexlang@nhs.net or visit our website here