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

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.”

Explore our AF work

Improving AF detection in high-impact settings.

Click to view our new reports

Contact us

Get in touch to find out more from the team.

Email us

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

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.

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

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

 

Hundreds of Londoner’s have pulse check after Mayor Sadiq Khan urges #knowyourpulse

Hundreds of Londoner’s have pulse check after Mayor Sadiq Khan urges #knowyourpulse

With 60,000 undiagnosed with the most common type of irregular heartbeat Atrial Fibrillation (AF) that can lead to a stroke, it’s important to #knowyourpulse.

The mayor’s message was backed by NHS England Medical Director Sir Bruce Keogh who issued a video message that can be viewed here urging people to #knowyourpulse. This campaign was backed up by the three London Academic Health Science Networks who ran free drop-in pulse check’s across the capital.

A simple, 30 second pulse rhythm check – either performed manually or using one of a range of new devices – can identify AF so that treatment can be provided.

The call comes after the Mayor had a test himself for Global AF Aware Week (20-26 November). The Mayor’s message can be viewed here.

At least 9,000 people were directly alerted to the campaign through Facebook and Twitter and the video messages have been viewed more than 1,000 times.

Over 150,0000 Londoners are affected by AF and of these an estimated 60,000 remain undiagnosed. Nationally, as the most common type of irregular heartbeat, AF is responsible for approximately 20% of all strokes. Stroke survivors must live with the disabling consequences and treating the condition costs the NHS across England over £2.2 billion each year.

This year’s Global AF Aware Week message was ‘Identifying the Undiagnosed Person with AF’. Londoners are being encouraged to spread the word about irregular heartbeats and urge friends and family – particularly those aged over 65 – to check their pulse and see a GP if it is irregular.

Pulse checks can be done manually (a British Heart Foundation video and guide shows how here) or through technology, with irregular rhythms investigated further by healthcare professionals.

The Mayor of London, Sadiq Khan, said:

“More than 150,0000 Londoners have the most common type of irregular heartbeat, which is called Atrial Fibrillation or AF, and are at higher risk of a stroke. Not everyone with AF has symptoms and a simple pulse rhythm check could save their life.

“I’m urging Londoners to have a free, 30-second pulse check this week during international AF Awareness Week. You can do this at one of the many awareness events happening across the capital this week, or ask your doctor or nurse.”

Professor Gary Ford, Stroke Physician and Chair of the AHSN Network Atrial Fibrillation Group, said:

“More than 60,000 Londoners are unaware they have Atrial Fibrillation which is responsible for 1 in 5 strokes. We have highly effective treatments that reduce the risk of stroke in people with AF.

“During Global AF Aware Week I am urging everyone, but particularly those over 65 to have their pulse rhythms checked. This simple check could prevent a stroke, which can have a devastating impact on their lives.

“I fully support the Mayor of London in his call for Londoners to have a simple check so that we can prevent strokes and ultimately, save lives and prevent long term disability.”