The challenge of rapid detection and diagnosis of atrial fibrillation (AF) has been made even harder with the onset of the COVID-19 pandemic, and the resulting disruption to appointments and restrictions of access to healthcare services. Against this backdrop, researchers are investigating the possibility of digital health technologies such as smartphone applications and wearable devices to detect potential AF and support remote diagnosis.
Harmandeep Singh, cardiology consultant and director and founder of Capitol Medicare, a CQC registered company specialising in providing faster diagnostics, analytics and real time remote virtual monitoring solutions to the NHS, discusses the latest digital health solutions in the space and the potential for greater remote care of cardiology patients.
In theory, as a heart rhythm disorder, diagnosing AF should be relatively straightforward. You can get an objective diagnosis through capturing data on cardiac activity. Why then are there an estimated 300,000 undiagnosed cases of AF in England?1
A key challenge is that, for some, it is a largely asymptomatic disease,2 many patients don’t know there is a problem until they are admitted to hospital after having a stroke or other medical emergency. There can also be delays with access to appointments and the technology required to diagnose AF, meaning that it can take weeks to receive a diagnosis.
Fortunately, AF is a condition that lends itself well to using technology to detect and diagnose remotely. Many patients are already having their diagnosis supported using the Holter monitor which they wear as they go about their day-to-day lives. In clinical practice, there are inevitable restrictions to using the Holter monitor as there is of course a finite supply of both equipment and qualified personnel, but what if we could obtain high quality data on cardiac activity over time using technology already in our patients’ pockets? For example, in the form of devices such as smartphones and smartwatches.
This question took on a new urgency following the arrival of the COVID-19 pandemic in our clinics. From the outset, almost all face-to-face appointments were cancelled in both primary and secondary care. Some patients are still finding it difficult to secure a GP appointment, and many will have been waiting for several months to receive AF investigations. Doctors are finding it difficult to make clinical decisions based on remote conversations, without being able to examine the patient face-to-face. Even now, most surgeries and hospitals are not running at full capacity.3 The estimated 300,000 undiagnosed people with AF may even now look a little optimistic, as one study found that diagnosis of cardiovascular conditions fell by 43% during the first three months of the pandemic.4
Even after the current wave of the pandemic subsides, social distancing and remote delivery of healthcare services are likely to be maintained for some time. The result of this will be ongoing capacity challenges in performing ECGs in primary care and providing Holter monitors in secondary care will continue to remain vastly limited. This will, in turn, cause further delays in the detection and diagnosis of AF, resulting in high-risk patients being put at an even greater risk of stroke.
Solutions to this challenge
To attempt to solve these problems, we at Capitol Medicare, have entered into a collaboration with the pharmaceutical company Daiichi Sankyo UK, and digital health technology companies FibriCheck and neoHealthTech. Our partnership will make our technologies, which consist of a smartphone application and direct to home real-time wearable echocardiogram monitoring device, available on the NHS in certain localities.
We are partnering with a number of Primary Care Networks (PCNs) to deliver select pilot projects and we hope to see results starting to come through towards the end of 2021. The premise is quite simple, yet these pilots have the potential to be hugely effective. Using remote monitoring can help conserve NHS resources, improve patient outcomes, reduce hospital footfall, and provide a more convenient experience for patients.
The safe and compliant monitoring and analysis of healthcare data has the potential to be truly revolutionary in terms of helping us to provide a modern and sustainable healthcare service. AF is a natural condition to focus on, given the significant unmet need and that cardiovascular disease (CVD) prevention is an important long-term national priority for the NHS. This is a truly exciting project to be involved in and I believe this approach can play an important role in alleviating the detection and diagnosis challenges in this area.
Harmandeep Singh is a cardiology consultant and director and founder of Capitol Medicare, a CQC registered company specialising in providing faster diagnostics, analytics and real time remote virtual monitoring solutions to the NHS. He is currently posted at the London North West University Healthcare NHS Trust, London, UK, having joined Ealing Hospital in 2009 as a clinical fellow.
1 The AHSN Network. Atrial fibrillation – detect, protect and perfect. Available at: https://www.ahsnnetwork.com/about-academic-health-science-networks/national-programmes-priorities/atrial-fibrillation Accessed July 2021.
2 NHS. Atrial Fibrillation: Symptoms. Available at: https://www.nhs.uk/conditions/atrial-fibrillation/symptoms/. Accessed July 2021.
3 British Medical Association. Pressure points in the NHS. Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressure-points-in-the-nhs Accessed July 2021.
4 Williams, R et al. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. The Lancet Public Health 5.10 (2020): e543-e550.
The final version has been reviewed for accuracy and compliance by Daiichi Sankyo UK Ltd in line with the ABPI Code of Practice.