To commemorate Stroke Awareness Month, former DigitalHealth.London Accelerator companies FibriCheck and Patients Know Best share how their digital platforms have facilitated the implementation of virtual atrial fibrillation (AF) services in hospital West Middlesex and Chelsea and Westminster Hospital, enabling remote care for patients with chronic illnesses.
Preview
FibriCheck is a medically certified and clinically validated digital health solution that uses commoditized electronic devices such as smartphones and wearables to make clinical pathways more efficient. Our technology enables early detection and monitoring of heart health issues through precise heart rate and heart rate measurements remotely, allowing users to track their symptoms, blood pressure and weight.
Traditional pathways relying on electrocardiograms (ECGs) often face challenges, including lengthy processes and high financial costs. Patients also experience prolonged wait times due to limited access to necessary equipment, posing additional health risks.
Innovative approaches such as virtual services are therefore crucial to address these issues to improve accessibility, efficiency and tailor care to individual needs. It simplifies care processes, reduces expenses, addresses disparities in access to health care and improves monitoring of patients whose health status changes.
Project Synopsis
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting around 1.4 million people in the UK. With current pressures on the NHS and health system, a more effective approach is needed to address workforce challenges, inpatient bed pressures and service constraints. It is believed that effective management of AF could preventing 7,000 strokes and saving more than 2,000 lives a year in England alone.
FibriCheck was successfully integrated into a virtual services project implemented at two hospital sites in North West London: West Middlesex Hospital and Chelsea and Westminster Hospital. Approved by NHS North West London, this project leveraged digital technology to manage patients with chronic conditions remotely, using real-time data from our Photoplethysmography (PPG) technology.
Patients Know Best (PKB) is a personal health record platform designed to bring together primary, secondary, community and patient data into a single record. The integration allowed us to send reports and heart rate measurements to the patient’s PKB record, which the clinician and patient could view along with the rest of their health data, providing a more holistic view of their health and their care. Monitoring their patients’ measurements, as well as their other health conditions, helps clinicians know when intervention is needed. All of this helps make virtual services possible.
73 patients diagnosed with AF were onboarded and used FibriCheck to monitor their heart rate twice daily and record their symptoms, replacing traditional in-person appointments. A dedicated digital monitoring center, managed by specialist nurses, facilitated first contact, provided ongoing support and carried out daily checks of measurements in case of anomalies. Cases requiring further attention were quickly escalated for follow-up as necessary.
The virtual pathway of the atrial fibrillation (AF) service
The following image shows how the atrial fibrillation (AF) virtual pathway works.
Patients eligible for the AF virtual service are registered on the Patients Know Best platform and introduced to the FibriCheck application, which they must download to their handset. Upon registration, patients learn how to take and record their measurements with the app. This includes a live demonstration, information leaflets, resources and a personalized care plan. Initial support is provided through the app’s digital monitoring center within 24 hours to answer any questions or troubleshooting needs.
Once patients are familiar with the app’s features, remote monitoring begins. Patients take measurements twice a day and record any symptoms they experience on the app. This data is securely transmitted via the cloud system to the Patients Know Best dashboard for review. Clinical staff monitor patients daily via the Digital Monitoring Hub, contacting them by telephone for reported abnormal parameters, missed downloads or patient inquiries. Any issues requiring escalation are promptly referred to senior clinicians to expedite clinical review or emergency admission if necessary.
Throughout the patient’s stay in the AF Virtual Department, weekly multidisciplinary team (MDT) meetings are held to discuss individual cases. These meetings facilitate decisions on the ongoing management and monitoring of AF, including additional monitoring if necessary. After discharge approval, patients are guided to routine or expedited follow-up appointments at specialty clinics or community care.
Impact/Results
This project has had a significant impact on workforce challenges, inpatient bed pressure, costs and patient satisfaction. Virtual services reduced the average length of stay per patient by four days, saving around £1,000 in direct cost per patient and providing more available hospital beds by promoting early discharge.
The feasibility and clinical utility of the virtual services model was also demonstrated in this setting. Patient feedback was overall positive, with 93% patient engagement in remote monitoring and 86% of patients indicating FibriCheck was easy to use. There was no change in emergency admissions after discharge and all 43 respondents indicated that they felt better cared for in the virtual AF department than if they had remained hospitalized.
This intervention facilitated early detection of deteriorating health status in 9 of 73 patients, resulting in appropriate recommendations to seek emergency medical attention or call urgent care services. Over a longer period of three months after the end of remote monitoring, only three patients were seen again with an arrhythmia-related presentation, and a clear cause can be isolated in each case. Our data demonstrate the safety and feasibility of a virtual ward model for AF care, with overall clinical benefit in both avoiding admission and supporting early discharge of hospitalized patients.
Doctor
The project has also demonstrated environmental benefits, such as reducing the need for patient transportation, which has a positive impact on the carbon footprint.
Next steps
In light of the increasing pressure on the national healthcare system, the NHS is actively promoting the expansion and implementation of virtual services. These services facilitate early discharge of patients and provide alternatives to hospitalization, which can significantly improve care outcomes and reduce healthcare costs.
This pathway can be scaled up easily at relatively low cost, making it widely accessible and applicable in NHS hospital trusts.
For more information, see the full research article at https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000475 or visit our Directory of innovations.
THE DigitalHealth.London Accelerator The program is funded by the UK government through the UK Shared Prosperity Fund (UKSPF). It is delivered by the Health Innovation Network (HIN) South London in partnership with the Office of Life Sciences, CW+, Medicity, NHS England, the Mayor of London and the Leveling Up Fund.
For more information, please visit https://www.gov.uk/government/publications/uk-
Shared Prosperity Fund prospectus.
