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FibriCheck: Decreasing Holter waitlists and preventing strokes with remote cardiac monitoring

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FibriCheck

Atrial fibrillation (AF) is a leading cause of stroke across the globe. The condition causes an irregular and abnormally fast heart rate.

Strokes due to AF tend to be more serious and cause more damage to the brain.

And with one in four stroke survivors at risk of a second stroke, AF monitoring is an essential part of post-stroke care.

Smartphone app FibriCheck is helping to diagnose AF sooner and easing the strain on overworked healthcare providers and systems.

Dr Devesh Sinha is a stroke consultant at Barking, Havering and Redbridge University Hospitals NHS Trust. He also leads the North East London Stroke Network.

The Trust is one of a growing number of health services to adopt FibriCheck, with clinics as far and wide as the Netherlands and Australia using the technology.

“Our existing system for detecting heart rate had almost collapsed, just like any other service during the pandemic,” Dr Sinha explains.

“As a matter of urgency, we needed to ensure that every stroke patient had some form of heart monitoring. That’s when we started thinking about options.

“The one option that stood out for us was FibriCheck. The technology allows us to monitor the heart and detect an irregular heart rate and rhythm while the patient is at home, minimising in-centre bed days.

“FibriCheck has now become our preferred method for remote cardiac monitoring.”

Traditionally, stroke patients are monitored with a Holter, which uses electrodes and a recording device to track the heart’s rhythm over 24 hours.

The device is fitted by a clinician either in the patient’s home, or after bringing the patient into the hospital via ambulance.

The cardio-respiratory team then sees the patient again to remove the Holter monitor and analyse the data.

This approach is hugely time consuming, resource-heavy and burdensome for stroke survivors, requiring ambulances, cardiac teams and hospital transportation.

During the peak of the pandemic, these resources were overwhelmed by Covid cases, leaving stroke survivors at a greater risk of slipping through the cracks.

Stroke survivors could be waiting for months for a Holter monitor.

And, as Dr Sinha explains, the only way to prevent a second stroke is taking an ‘ABC’ (Atrial fibrillation, Blood pressure, Cholesterol) approach to management.

In early 2021, the Trust launched a post-stroke discharge project with FibriCheck to accelerate care and triage growing Holter waitlists. The impact was immediate.

Dr Sinha explains how it works in practice.

“We ask stroke patients to download the FibriCheck app upon discharge.

“When they get home, they periodically put their finger on the smartphone camera to take a reading. It’s as simple as that.

“Before, a patient could have a secondary stroke while waiting for six months for a Holter. Now, the patient can have their AF detected, diagnosed and treated within 24-48 hours. It’s a phenomenal change.”

The Trust conducted an audit of the Holter system prior to Covid.

The de facto heart rate detection method was found to be less than 1 percent successful at detecting AF. FibriCheck has improved AF detection to five percent.

Quite simply, the longer a patient is monitored, the greater the chance of the arrhythmia being found and the sooner the patient is treated, ultimately preventing a debilitating or fatal secondary stroke.

Implementing technology of any kind is not without its challenges, with digital inclusivity being the first major hurdle.

Strokes are far more common among older people who are often thought to be less familiar with smartphone technology. But age proved not to be a factor.

“What we actually found was that stroke patients often have someone around to help them use the app,” Dr Sinha says.

“It could be a granddaughter who will do everything to make sure that their grandmother doesn’t have another stroke.

“The feedback from patients was amazing. You see the whole family come together.”

“I think we had an 80 to 85 percent compliance rate when we started. So that was the first challenge overcome.”

There were also initial concerns from internal stakeholders about the technology being validated. But there’s more than a wealth of evidence to justify using FibriCheck.

“Change management and people management is always going to be a concern with adoption of any new technology,” Dr Sinha says.

“But once people start doing it and developing confidence that the process works, your patient becomes your advocate and your staff becomes your enabler.”

Advance Nurse Practitioner and Stroke Ambulatory Lead Jiji Philip, shares her experience on leading this service for the Trust:

“When a patient is referred to us by their GP or the A&E department, we first need to do basic cardio investigations to determine next steps.

“FibriCheck allows us to do this immediately and the patient goes home happy because they have something to check with to help them monitor if anything is coming up.

“The patient gets the report as well, but they don’t need to worry because we can also see it from our centralised dashboard.

“If there is anything unusual that needs to be corrected, we can immediately contact them, making our job that much easier.”

During Covid when the system was first implemented, FibriCheck was given out to 108 patients, of which 42 were post-stroke and 66 were post-TIA.

Of all the patients that used FibriCheck for seven days, 103/108 (95.4 per cent) were not detected with AF.

As a result, AF was ruled-out and they didn’t need an ECG/tape, which positively influenced the Holter waiting lists.

In total, 5/108 patients (4.6 per cent) were positive for AF based on FibriCheck. After AF detection, an ECG tape was done, all 5 patients were confirmed to have AF.

The success of this work led the Trust to adopt the technology as part of routine practice and FibriCheck has now been given to 187 patients within the pathway.

Due to its ease of use, both staff and patients experienced accelerated care outcomes through evidence-informed decision making, efficient in-consult resolution and patient engagement.

By initiating AF detection and follow-up virtually with FibriCheck, the Trust saved staff time, and overcame device scarcity and turnover logistics.

Fewer in-clinic visits, reduced patient travel, the risk of hospital acquired infections and care coordination, decreasing caregiver burden.

Further, instant activation improved experience and addressed worried post-stroke patients who, at times, may misappropriate discomfort and stress as something more severe, which often results in avoidable admissions, repeat appointments and increased care expenditure.

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  1. Pingback: Visionable and Brainomix announce strategic stroke partnership

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