Collaborations with FibriCheck throughout the patient pathway

Comprehensive media campaign demonstrates the potential of at-home diagnosis

Objective: To investigate the feasibility of population based approach to detection of atrial fibrillation via a comprehensive media campaign. Assessing the potential impacts to clinical care.

Project outline: In what is probably the clearest demonstration to date of FibriCheck’s scalability potential, the solution was put to the test as part of a comprehensive country-wide detection and awareness raising campaign in Belgium. The call for participants for this nationwide study was published both online and in print, with collaboration support from several major news outlets. In addition to supporting the recruitment of over 62,000 study participants, the campaign successfully increased public awareness about atrial fibrillation, reaching over 2 million people in total.

Conclusion: 62,821 people activated and downloaded the FibriCheck app via QR codes published in various newspapers and online media. Over 98% of participants completed the 8-day programme, taking 60-second measurements with their smartphone 1-2 times per day and additionally when experiencing symptoms. The resulting PPG data (over 588,000 measurements in all) was first analysed by the FibriCheck app and then validated by skilled medical technicians to assess the accuracy of the algorithm’s findings under the supervision of cardiologists. The result? 791 (1.3%) cases of possible atrial fibrillation were detected, illustrating the significant impact large scale detection programmes can have on population health outcomes improvement. While, the diagnostic yield for AF increased from 0.5% with one measurement to 1.8% after 8 days, this was untargeted, opportunistic case finding. When applied in a targeted approach to high-risk cohorts, these results would be even higher, owing to the gains associated with prolonged and on-demand measuring potential. Which is especially crucial in the early stages of AF, when episodes are largely intermittent and difficult to capture during routine appointments. In addition to proving a tripling in detection rate by monitoring over the course of a week, compared to a single spot-check, 65% of participants reported benefit in the referral of irregular results to their physician. Most importantly, this project confirmed the feasibility and potential cost-effectiveness of supervised digital screening at scale. Further demonstrating that the yield of new AF cases did not increase excess burden on the healthcare system.

Empowering people to take control of their health via population health screening in Luxembourg

Objective: To boost the efficacy of traditional, industry-sponsored awareness campaigns via innovative technology that empowers Luxembourg residents to play an active role in their own diagnosis.

Project outline: As part of Heart Health Month, FibriCheck partnered with the Luxembourg Ministry of Health, Cardiology Society, Patient Association and the Pfizer-BMS Alliance to co-develop a nationwide detection programme to raise awareness and improve atrial fibrillation detection rates in the general population. As the digital enabler of the campaign via on and offline media, the FibriCheck app played an integral role in engaging both healthcare professionals and the general public. . The two-pronged approach to the campaign consisted of an awareness phase focusing on heart health, lifestyle and prevention and a screening phase in which the public could use FibriCheck for free for 7 days.

Conclusion: There are at least two shortcomings of traditional, industry-sponsored health awareness campaigns. Firstly, they lack a concrete mechanism to prompt people to take action and seek medical advice. Secondly, they lack meaningful and actionable data that can be used to facilitate treatment and evaluate the performance and impact of the campaign itself. As a crucial component in this nationwide disease awareness campaign, FibriCheck proved its scalability and agility in solving both these issues. On the one hand, it empowers people to play an active role in their own diagnosis with a strong focus on prevention, thus giving them tangible incentives to seek further medical help. On the other, it generates extremely valuable data and insights that can streamline the process of care while yielding clear KPIs and response rates. As of the time of writing, an estimated 12,000 people in Luxembourg suffer from atrial fibrillation; a figure which is expected to double by 2050. By offering large cross-sections of the population a certified, hardware-free diagnostic solution to detect arrhythmias such as atrial fibrillation, FibriCheck demonstrates the transformative power of digital health in improving patient outcomes and potentially saving lives.

Belgian health insurer Helan offers its clients free use of FibriCheck for a year.

Objective: Meeting the needs of clients to be empowered in disease prevention by giving them free access to FibriCheck for a year.

Project outline: By offering the free use of FibriCheck for a year, health insurers can be on the innovative forefront of healthcare, shifting the focus from treatment and follow-up of disease to a more preventative model. By doing so, health insurers can meet the evolving needs of their clients and offer them multiple solutions and initiatives to support health and wellbeing, while also reducing pressure on the already overstretched healthcare system. 

When introducing FibriCheck as a digital solution, AF can be detected in the early stages leading to improved outcomes and a significant reduction in cost. Besides that, FibriCheck can also aid those who already have a confirmed diagnosis by serving as a monitoring tool. This also has a positive impact on the relationship between clients and their insurers as it provides reassurance and additional options in their health management. 

During the first year of this project, more than 6.000 clients of Helan measured their heart rhythm with FibriCheck. In total, this summed up to 200.000 performed heart rhythm measurements.

Due to its success, this collaboration has been renewed for another year. This is an important step forward, as heart rhythm disorders can appear at any moment, which makes it important to perform regular heart rhythm checks. In combination with our new blood pressure feature, Helan members can now track various vital parameters, which gives them a more comprehensive understanding of their cardiovascular health.

Partnering with the popular wellness tracker provider to drive positive health outcomes

Methods: To bring the proven benefits of FibriCheck’s remote heart monitoring solution to Fitbit smartwatch users in Belgium, the Netherlands, Ireland, UK, France, Germany, Italy and Spain.

Project outline: FibriCheck’s device-agnostic solution allowed it to be easily integrated into Fitbit’s extensive range of consumer wearables. By leveraging the built-in photoplethysmography (PPG) sensors, available in virtually all devices, FibriCheck developed a fully compliant and fully compatible app that runs on Fitbit OS. Enhancing their value proposition for prospective buyers boosting functionality for existing users.

Conclusion: FibriCheck’s partnership with Fitbit aligns with the company’s vision to help transform the lives of millions of consumers around the world. It does so by offering wearable users a low-threshold way of measuring and detecting irregular heart rhythms that frequently go unnoticed until it’s too late. Users can view the results of their measurements in real time and gain a better understanding of their own heart health, either directly on their smartwatch or via their smartphone. Most importantly, those results can be instantly and automatically shared with the user’s doctor via FibriCheck’s robust cloud infrastructure. Helping to inform diagnosis and potentially life-saving intervention. As such, the FibriCheck app for Fitbit brings the power of FibriCheck’s medically-certified, regulatory-approved and clinically-tested solution to potentially millions of consumers’ worldwide. Since its launch in September 2019, over half a million heart rhythm measurements have been made using Fitbit devices, realising the benefits of mhealth innovation to a whole new cross-section of the public and improving the health outcomes for thousands of users.

Bringing the benefits of mHealth to a whole new group of users

Methods: To capitalise on the increasing popularity of wearables in order to offer an even broader user base an easy and convenient way to measure heart rates and rhythms via smartwatch.

Project outline: Amidst the growing uptake of digital and mobile health solutions and against the backdrop of significant growth in consumer wearables, such as smartwatches, FibriCheck collaborated with Samsung to develop a smartwatch app that was not only fully compatible with the new Samsung Galaxy Watch3 and Galaxy Watch Active2 but even transformed them into fully certified and approved medical devices. FibriCheck was selected by Samsung on the strength of its regulatory portfolio, having obtained approval in the US, Australia and Europe. As a result of the agreement, potentially millions of Samsung users now have access to FibriCheck’s solution via the convenience of a consumer wearable device.

Conclusion: Even within just one month of being made available, several thousand users took advantage of an introductory offer to download the FibriCheck smartwatch app to detect potential heart rhythm disorders simply while wearing their Samsung Galaxy Watch3 or Galaxy Watch Active2. As well as add value for users, this integration is yet another demonstration of how FibriCheck can help manufacturers compete in the fight for consumers by offering new and innovative total solutions. FibriCheck’s software is unique in that it analyses the raw signals generated by the PPG sensor built into almost every smartwatch and consumer wearable. As such, FibriCheck can be easily integrated within a whole range of devices and across all platforms. Coupled with the platform’s international reach, proven ease of use, robust compliance and regulatory approvals FibriCheck was a clear choice to extend the functionality of the Samsung Galaxy Watch3. Moreover, the added convenience for users to instantaneously measure their heart rate and rhythm via their watch, brings mHealth to an even broader audience and allows an even larger user base to take advantage of FibriCheck’s life-saving technology.

Enabling pharmacists to lead AF awareness and detection efforts in the community

Introduction: In meeting people where they are, pharmacists are uniquely placed to deliver effective place based care owing to their positioning within community settings. Their regular engagement with high-risk individuals with long term conditions affords an effective mechanism to raise awareness about the risks of cardiac arrhythmias. This collaboration pilot with the Belgian association of community pharmacists (Royal Association of Limburg Pharmacists – KLAV) demonstrated the enormous value pharmacy networks can bring to communities by increasing detection rates, especially for those who have asymptomatic atrial fibrillation.

Objective: To investigate the potential future spread of pharmacist-delivered atrial fibrillation education and remote screening within community pharmacies via awareness raising. In partnership with KLAV, FibriCheck and member pharmacists aim to increase detection rates.

Project outline: As a first point of contact for many patients, pharmacist networks have enormous outreach potential. This project was designed to qualify and quantify the potential for increasing timely detection of cardiac arrhythmias. Participating pharmacists invited customers to use the FibriCheck app over a 7-day period. They were advised to perform measurements twice daily and whenever they experienced symptoms such as palpitations, chest pain, dizziness, etc. The consolidated end-reports were forwarded by e-mail to the user along with the advice to consult a general practitioner in cases where atrial fibrillation was detected.

Conclusion: FibriCheck remote monitoring was met with positive reception, both by pharmacists and their customers. A small region was selected to pilot the approach, from which 110 people participated. A total of 19 (17.3%) cases of possible arrhythmias were detected. 13.6% were non-atrial fibrillation (AF) arrhythmias and 3.6% were identified as possible AF. All possible AF cases were advised to consult a doctor, which resulted in further investigation, timely treatment and in the case of 1 patient, surgical intervention to prevent future strokes. The insights generated by this project clearly illustrate the important role pharmacists can play in ensuring timely detection of AF and broader condition awareness in a community setting.

Reducing the burden and mortality of AF with a digital screening and intervention strategy

As early diagnosis of AF combined with appropriate therapy can reduce the risk of stroke and its associated mortality rates, the clinic for cardiology and angiology of the University of Innsbruck aims to develop an Austria-wide digital screening and treatment strategy in collaboration with FibriCheck. 

In a previous study, the department already demonstrated that a digital screening strategy can more than double the detection rate of treatment-relevant atrial fibrillation. In this new study, they want to develop, implement and validate an atrial fibrillation screening and treatment strategy that uses digital technology in order to reduce the burden of disease and mortality associated with AF. This screening strategy will be rolled out nation-wide in Austria. 

Axel Bauer, director of the clinic for cardiology and angiology stated that “Digital technologies hold immense potential for medicine and could revolutionise the early detection and treatment of atrial fibrillation.”.

The free use of FibriCheck can empower more than 3 million members of CM to take control of their heart health

More than 3 million members of CM, the biggest health insurer in Flanders, can now enjoy a reimbursement that enables them to use FibriCheck Essential for free for a year. With this reimbursement, we want to empower CM members to take control of their own heart health by enabling them to follow up on vital parameters such as heart rate, heart rhythm and blood pressure and by providing them with educational content. 

The timely detection of heart rhythm disorders can enable early treatment, which can prevent serious complications and the costs that they bring along. With our medically certified technology, heart rhythm disorders can be detected and monitored remotely  without the use of any additional hardware, which can drastically improve clinical pathway efficiency for both users and healthcare providers.

Through our partnerships with both CM and Helan, 1 out of every 3 Belgians can have free access to FibriCheck, which helps support the detection and monitoring of heart rhythm disorders on a large scale.

Can FibriCheck support cross-condition management within COPD patients?

Objective: Various studies suggest that COPD patients have an increased risk of developing AF. This study by Khan et al aimed to evaluate whether PPG-technology could be an accurate and effective solution to remotely monitor heart rate and heart rhythm in COPD patients.

Project outline: A group of patients with a confirmed diagnosis of COPD and access to a smartphone was invited to monitor their heart rhythm remotely with FibriCheck for a period of 7 days. None of the patients was previously diagnosed with AF. If AF was detected, the patient was invited for a confirmatory ECG to establish the AF diagnosis. Out of the 90 patients that participated, FibriCheck detected a possible case of AF in 5 patients. These participants were brought in for an in-office 12-lead ECG, which immediately confirmed AF in 3 out of 5 patients. The other 2 patients were diagnosed with paroxysmal AF after prolonged monitoring or hospital admission. This diagnosis led to the initiation of guideline-based AF management.

Conclusion: Remote heart rhythm monitoring using FibriCheck resulted in the detection of new AF cases which were later confirmed with an in-office 12-lead ECG. This makes the use of FibriCheck a feasible option for the cross-condition management of COPD patients.

Empowering patients to better understand and manage their health and care.

Objective: How FibriCheck’s remote cardiac monitoring is supporting virtual wards and alignment to usual care pathways. 

Project outline: Chelsea and Westminster Hospital is one of many UK centres working with Patients Know Best (PKB) to empower patients to be more engaged in their health. Having developed a Same Day Emergency Care (SDEC) pathway, which seeks to rapidly assess, diagnose and treat patients and – where clinically appropriate – discharge them home on the same day, the pathway shortens the patient’s length of stay in the hospital, thereby creating much needed bed capacity. 

With over 1.5 million users, Patients Know Best is the UK’s leading personal health record provider. Users can upload all of their personal health data such as test results and symptom tracking info as well as link with applications such as Strava and Fitbit. Its true impact  is realised by its connection with provider systems. By enabling patient-reported data and clinical data to be looked at holistically, the platform provides better outcomes for both patients and the healthcare system. 

Improving access for high-risk patients in  parallel with vaccination programme

Introduction: COVID-19 restrictions posed a challenge for general practitioners (GPs) to maintain the standard of care for at-risk patients. By replacing in-centre checks with FibriCheck, Wanstead and Woodford Primary Care Network (PCN) had a powerful at-home tool to improve AF detection rates and patient outcomes, safely and efficiently.

Objective: To safeguard continuity of care during the pandemic via remote monitoring. Achieving performance targets, AF detection metrics and better patient outcomes through primary care vaccination initiatives.

Project outline: With many patients hesitant or simply unable to attend clinic appointments due to the pandemic, Wanstead and Woodford PCN were searching for a way to reduce stroke risk and address their AF detection targets, without increasing the burden on acute care services. The solution came in the form of FibriCheck’s remote monitoring platform. The project was rolled out as part of the PCN’s Flu and COVID-19 vaccination programme, ensuring virtual access to care for at-risk patients and improving efficiency for healthcare professionals (HCPs).

Conclusion: The project is a strong demonstration of just how effective and efficient remote AF detection can be with FibriCheck. The remote monitoring programme achieved a 100% approval rating from both patients and practitioners. All participating HCPs indicated that they would recommend the platform to their colleagues. All practices within the network also agreed that the solution was beneficial and even enhanced their ability to carry out AF detection. The pathway not only simplifies detection and monitoring of at-risk patients, it also facilitates the next steps in treatment and care. Fibricheck enabled HCPs to easily rule out innocent presentations and prioritise those that required further investigation. This significantly reduced the number of referrals for 24h Holter monitors. Most significant, however, were the high adoption and approval ratings amongst patients. 97% of patients found the installation and use of the FibriCheck app easy. By combining the roll-out of the project with the network’s vaccination efforts, HCPs were also able to reach more patients safely and efficiently.

Regional roll-out of FibriCheck’s palpitations service to GP practices across Staffordshire and Stoke on Trent

Objective: To better manage service demand in their region, the Staffordshire and Stoke on Trent Integrated Care System (ICS) implemented FibriCheck as the first line of prescription for patients experiencing palpitations. Rather than waiting weeks for a hospital appointment, patients and their GP can now benefit from timely access to care from the comfort of home. Saving in some cases an unnecessary trip to the Emergency Department.

Project outline: With a total of 146 GP practices participating in the roll-out of this newly developed palpitations management pathway, the project’s primary aim is to triage patients experiencing palpitations more effectively so as to reduce unnecessary appointments and diagnostic referrals. Ultimately decreasing wait times and resources in both primary and secondary care.

FibriCheck is now being offered by primary care networks across the Staffordshire and Stoke On Trent area to all patients presenting with palpitation complaints. Each participating practice is equipped with their own FibriCheck code, which staff can instantly provide when the patient calls to request an appointment. Patients can now self-check during these episodes, providing real time insight and reassurance to both themselves and their provider. Aligned to regionally transforming care pathways, monitoring data will be centrally managed by 1 of the 3 hubs across the area.

FibriCheck’s measurement results will be used to inform decision-making for the next steps in care. Effectively creating capacity within the system for those that need it most and driving better outcomes at scale.

Improving the management of AF within a group of elderly, multimorbid patients

The EHRA-PATHS project is an initiative to address multimorbidity in elderly (65+) patients suffering from atrial fibrillation. This project is funded by Horizon 2020 and aims at transforming the clinical practice in the field of AF from a single-disease focused approach, to an approach that also considers gender, polypharmacy and comorbidities such as hypertension, coronary artery disease, metabolic conditions, renal conditions and respiratory conditions. 

This project aims at creating awareness for the importance of treating comorbidities within AF patients. The idea is that by transforming the current pathway into an interdisciplinary, patient-centered, systematic care pathway, cross-conditions can be managed more efficiently. This approach would also lead to a possible estimated reduction of €20 billion in healthcare burden of multimorbid, elderly AF patients across Europe yearly. 

In total, the EHRA-PATHS project will take 5 years to complete. Currently, 2 years have already passed, in which the focus was on developing care pathways and the software needed for this interdisciplinary approach. In the beginning of 2024, the randomized trials will start in order to conclude whether the software helps addressing comorbidities within elderly, multimorbid AF patients. 

FibriCheck is involved in this project by providing a backbone for the EHRA-PATHS platform. We’re happy to provide our expertise and to jointly transform the way cardiac care is delivered!

Revolutionizing cardiac care: A digital pathway empowering patients and optimizing efficiency at Rijnstate hospital

In order to improve the efficiency of the cardiology department at Rijnstate, a Dutch healthcare provider, we provided support in creating a digital care pathway. 

In this pathway, patients are empowered to check their own heart rhythm remotely using FibriCheck. They are also asked to fill out questionnaires in the patient portal of Rijnstate. Nurses monitor this digital pathway remotely to check the health status of patients. 

With this approach, patients only need to come in when necessary, which frees up time for both patients and cardiologists. This decreases the pressure on the cardiology department, and allows for hospital resources to be deployed more efficiently. Additionally, the portal also guides patients throughout the process, so that they clearly know which steps to take.

Raising awareness and increasing the AF detection yield in Hong Kong through large-scale targeted case finding programme

Project outline: FibriCheck has partnered with Roche Diagnostics, Hong Kong’s leading digital health platform DrGo and the Hong Kong Society of Rehabilitation (HKSR) for a large-scale targeted AF detection campaign among Hong Kong’s population. Following a successful FibriCheck integration, Hongkongers are now able to measure their heart rhythm anytime, anywhere via the DrGo app.

Residents will be offered free access to FibriCheck in the DrGo app for 14 days. During this period, they will be asked to check their heart rate and rhythm twice a day (in the morning and the evening) with additional measurements whenever they are experiencing symptoms (e.g., heart palpitations or shortness of breath).

If the FibriCheck results show that there is a possibility of atrial fibrillation, they will receive a follow-up phone call or email from HKSR, recommending them to conduct further tests. Those who are detected with atrial fibrillation will be advised to seek necessary medical attention.

The goal of this strategic partnership is to have 100,000 persons use FibriCheck via the DrGo app to help close the detection gap for atrial fibrillation in Hong Kong.

Providing more joined up care through a remote end-to-end digital AF pathway

Project outline: As part of more joined up care and better Long Term Conditions (LTC) management, a remote end-to-end digital pathway is now being offered to patients of West Suffolk Hospital who may be at higher risk of developing atrial fibrillation without knowing it.

After risk stratification and an eligibility check, patients receive an automated text message to download the FibriCheck app and automatically activate a 7-day FibriCheck activation code.

Patients are then instructed to measure their heart rhythm twice a day for seven days and whenever experiencing symptoms. After the FibriCheck monitoring period, results are reviewed by the cardiology team at West Suffolk Hospital.

In case further investigation is required, patients are invited to use an ECG patch to confirm FibriCheck’s findings and help establish a diagnosis. Once the diagnosis is established, patients are contacted by one of the specialist clinical teams to discuss treatment if applicable.

Raising awareness and improving AF detection rates in the MENA region through large-scale targeted case finding programme

Project outline: FibriCheck partners with Pfizer and AlTibbi to raise awareness and improve atrial fibrillation detection rates in the MENA region.

Via a national disease awareness campaign, people in the United Arab Emirates will be informed about atrial fibrillation and its related risks and will be invited to download the AlTibbi app to check if their heart rhythm is regular. Following a risk stratification, at-risk users will be asked to monitor their heart rhythm with FibriCheck for 7 days. When FibriCheck detects atrial fibrillation, AlTibbi will then facilitate booking an appointment with a cardiologist to establish a diagnosis via an ECG and if needed, provide the necessary care in order to prevent worse, e.g. a stroke.

The goal of this active targeted case finding programme is to identify and reach 100,000 persons at-risk of developing or suffering from atrial fibrillation to close the detection gap for atrial fibrillation in the region.

Pilot project to explore future models of primary care

Objective: To increase detection rates of atrial fibrillation (AF) in primary care while generating new insights and health economic data to support the case for change in partnership with Daiichi-Sankyo.

Project outline: The NHS’s ‘Long Term Plan’ encompasses multiple digitisation projects. These projects are aimed at harnessing the power of digital solutions such as FibriCheck to increase both the effectiveness and cost-efficiency of care. In this context, FibriCheck’s solution for at-home detection and monitoring of heart rhythm disorders such as atrial fibrillation is well aligned with the NHS’s future vision. This pilot project involving 5 UK primary care networks (PCNs) is the first step towards national roll-out of a completely digital pathway. As a joint working project with pharmaceutical company, Daiichi-Sankyo and several other technology partners, this pathway project aims to bolster the growing repository of evidence around the effectiveness and efficiency of remote care delivery and its impact on patient outcomes, detection rates, time to diagnosis and overall efficiency and cost effectiveness to standard clinical care.

Conclusion: There are currently no remote end-to-end AF detection or diagnosis pathways embedded in the NHS. This pilot project is a landmark initiative and a crucial first step in a partnership aimed at boosting the detection and diagnosis of atrial fibrillation, while giving at-risk patients improved access to the right treatments at the appropriate time. All without increasing the burden on the healthcare system. While the pilot project is still ongoing, early reactions from stakeholders to the FibriCheck solution, interface and accompanying support material have been extremely positive. More detailed findings will be published here in due course, as the final submissions to NHS England and NICE are prepared.

Awareness raising and public screening during Heart Rhythm Week

Objective: To boost public awareness of heart arrhythmias together with the Belgian Heart Rhythm Association (BeHRA), by targeting 10,000 high-risk patients to remotely self-screen during Heart Rhythm Week.

Project outline: As part of Heart Rhythm Week (7 to 13 June 2021), BeHRA launched a nationwide screening campaign until October 2021. The campaign invites people from across the country to complete an online risk assessment survey to identify and enable those with a heightened CHA2DS2-VASc score to receive a free, 7-day FibriCheck prescription to self test at home. The results of this targeted screening programme will help grow the repository of evidence around digital screening for public health promotion.

Conclusion: As public screening campaigns are typically untargeted, this project highlights the ease, impact and efficiency that come with pairing digital health tech with online engagement initiatives. This campaign illustrates the scale and impact of FibriCheck collaborations with medical societies and trade associations. This public health partnership is but one example, demonstrating FibriCheck’s credibility amongst the clinical community, in raising detection rates for potentially life-threatening heart rhythm disorders and, by extension, improving patient outcomes and quality of life. The precise magnitude of that impact in this specific project is yet to be determined, pending the completion of the screening programme. Stay tuned for the final results, which will be published here in due course.

Improved patient outcomes as a result of remote monitoring and active case-management in the Our Hearts Our Minds programme

Project outline: Over at the Western Health and Social Care Trust in Northern Ireland, patients living with or in risk of cardiovascular disease are being actively case-managed during a 10-week supervised exercise and education programme in terms of their risk factors and medication. The programme takes place under the supervision of a Consultant Cardiologist and with the support of cardiovascular nurse specialists, dieticians, physiotherapists and a psychologist.

Following an initial assessment with the multidisciplinary team that focuses on the patients’ lifestyle, medical risk factor, medication and psychological health, patients were remotely monitored by using a Fitbit smartwatch in combination with FibriCheck. If an abnormality is detected in their heart rhythm, this is then conveyed automatically to the cardiologist who can arrange further tests.

According to the Trust, patient feedback has been extremely positive with patients reporting that their quality of life has improved.

The AF stroke prevention hub program increases the AF detection yield and reduces the burden on GPs

Project outline: The AF stroke prevention hub program of the Barking, Havering and Redbridge University Hospitals Trust in the UK offers a valuable end-to-end pathway for the identification, detection, diagnosis, treatment, and management of at-risk patients that is more efficient for both patients and physicians. 

In order to improve the detection yield of AF in treatment-relevant patients, the program defined a group of patients that were at risk of suffering from AF. These patients were asked to follow up on their heart rhythm for 7 days using FibriCheck. 

If the results were normal, patients received reassurance advice from the hub nurse, which contained valuable information for self management, risk factors and awareness around AF. 

In cases where FibriCheck detected AF, the patient was asked to visit the hospital for a confirmatory 12-lead ECG or 7-day Holter. Once diagnosed, anticoagulation therapy was discussed with the patient and initiated immediately, thereby drastically improving the efficiency of the pathway and the outcome of AF.

The Barking, Havering and Redbridge University Hospitals Trust was recognized by the AF association as an AF pioneer for this program and is shortlisted for a HSJ digital award, which celebrates innovation and excellence in digitising and transforming healthcare.

Reducing Holter-device waiting lists by monitoring post-cryptogenic stroke patients remotely

Objective: To implement the use of smartphone-based remote monitoring in order to reduce Holter wait times and to improve the detection yield in cryptogenic stroke patients

Project outline: Over at Barking, Havering and Redbridge University Hospitals, FibriCheck has been implemented so that post-stroke patients could monitor themselves at home to detect atrial fibrillation. The goal of this implementation was to accelerate care and to reduce the increasing waiting time for Holter devices.

“Before, a patient could have a secondary stroke while waiting for six months for a Holter,” explains Dr. Devesh Sinha, Chief Clinical Information Officer and Clinical Lead Consultant Stroke at Barking, Havering and Redbridge University Hospitals NHS Trust. “Now, the patient can have their AF detected, diagnosed and treated within 24-48 hours. It’s a phenomenal change.”

Both staff and patients experienced improved care outcomes as FibriCheck made the post-stroke monitoring process more efficient. Because of the success of this implementation, this new way of working has since become part of the hospital’s routine practice.

Can PPG-technology yield the same results as an insertable cardiac monitor?

Project outline: In this ongoing remote trial, patients of the hospital Ziekenhuis Oost-Limburg (ZOL) who had suffered a cryptogenic stroke or a transient ischemic attack (TIA) received an insertable cardiac monitor (ICM) and were also asked to use a blinded PPG-based mHealth app on a wearable device (FibriCheck). During this trial, 68.748 1-minute recordings were collected with FibriCheck.

The ICM algorithm detected AF in 10 patients, and other cardiac arrhythmias in 19 patients. These results were checked by a remote monitoring team, which confirmed AF in 1 patient and other cardiac arrhythmias in 5 patients. The confirmed case of AF was also registered by the medically certified FibriCheck algorithm.

Conclusion: FibriCheck was able to detect the confirmed case of AF, which accentuates the potential role that PPG may have in long-term monitoring of cryptogenic stroke patients. The advantage of PPG as compared to ICM is that it is non-invasive, less expensive, and can be used anywhere at any time. This trial also concluded that even state-of-the-art ICMs have their limitations, as they yielded many false-positive results.

Evaluating the potential of watchful waiting via remote, real-time monitoring

Objective: To evaluate the effectiveness of a watchful-waiting approach and to prove it is at least as, if not more, beneficial than routine care pathways consisting of either early or delayed cardioversion.

Project outline: At present, the standard approach to treating acute episodes of atrial fibrillation involves so-called acute or delayed cardioversion. However, this multi-centre randomised controlled clinical trial initiated by Maastricht University Medical Center evaluates the potential benefits of a “watchful-waiting” approach where rate control medication is administered with a view to alleviating symptoms. As part of the trial, FibriCheck’s innovative and fully scalable telemonitoring infrastructure is used to guide rate control in real time and without the need for additional hardware. After discharge from the emergency department, all patients continue using the FibriCheck application for four weeks to monitor for recurrences and to guide ongoing rate control therapy.

Conclusion: The fact that FibriCheck’s remote monitoring platform is both scalable and fully compatible with a wide range of consumer devices means that there is real potential for a watchful-waiting approach. As well as enabling physicians to adapt therapies in accordance with regular and real-time data, such an approach could radically transform routine care and improve outcomes for atrial fibrillation outpatients. Once finalised, the results of this study will provide a more accurate impression of these potential benefits. The study is expected to be completed around June 2025. Stay tuned for more details as they become available.

Confirming persistent AF pattern by remote monitoring before therapeutic intervention

Objective: FibriCheck was used by the Maastricht University Medical Center+ to remotely monitor patients with presumed persistent AF that were scheduled for an electrical cardioversion procedure. The aim of monitoring was to decrease the number of unnecessary procedures by detecting cases of paroxysmal or self-terminating AF. 

Project outline: The TeleConvert AF study is an extension of the TeleCheck-AF project, which is a project that consists of on-demand remote monitoring around teleconsultations and/or interventions. 

The TeleConvert AF study applies FibriCheck’s PPG-technology to monitor patients with presumed persistent AF that are scheduled for an electrical cardioversion procedure. The case-coordinator explained the use of FibriCheck to the patients and followed up on their use of the app. Patients were asked to measure their heart rhythm 3 times a day. They were also asked to perform additional measurements in case of symptom onset. 

By monitoring this group of patients with FibriCheck, the heart rhythm could be studied in the period leading up to the procedure, thereby noticing cases of paroxysmal or self-terminating AF. In cases where the sinus rhythm detected by FibriCheck was confirmed, the scheduled electrical cardioversion procedure was canceled and rhythm control medication was amended as per the physician’s instructions. 

Those whose PPG-results did demonstrate a case of persistent AF were advised to keep their scheduled appointment for electrical cardioversion. All patients were asked to monitor their heart rhythm for 4 additional weeks after the cardioversion appointment.

Objective: The objective of the SURGICAL-AF 2 randomised controlled study is to evaluate the clinical consequences following the detection of postoperative atrial fibrillation or flutter using a remote heart rhythm monitoring strategy. The study takes place in a predefined subgroup of 600 participants using FibriCheck’s PPG-based smartphone technology in the early postoperative period after discharge.

Creating a nurse-led digitally-enabled pathway with FibriCheck

Project outline: At the Essex Cardiothoracic Centre, patients were given seven-day prescriptions to FibriCheck before their 3 and 12-month appointments following an ablation procedure to treat AF. The leading arrhythmia nurse received the summary of the measurements prior to the in-person appointment. 

Out of the 147 patients who participated, FibriCheck detected AF recurrence in 39 (26.5%) patients. Because of the use of FibriCheck, the use of an estimated number of 147 ECGs and 55 seven-day Holters was avoided, which translates to an estimated net savings of £19,040 and 73.5 outpatient clinic hours. 

This project was presented at the Heart Rhythm Society experience (HRX) by lead arrhythmia nurse of the Essex Cardiothoracic Centre Sharon Toora, and was selected as one of the top 5 abstract submissions. The project has also won a global cardiovascular award in the digital innovation category!

Conclusion: FibriCheck transformed the clinical pathway of the Essex Cardiothoracic Centre into a digitally-enabled pathway led by arrhythmia nurses in which ECGs and Holter devices were replaced. This translated into direct financial savings, but also into time savings, allowing for increased efficiency of the hospital service. In the future, this project will expand and FibriCheck will be used to follow up on patients who underwent a cardioversion procedure as well.

Dutch hospital uses FibriCheck to follow up on recurrence after AF-treatment

FibriCheck is a versatile tool that can be used in many clinical pathways. This collaboration with the Groene Hart Ziekenhuis in Gouda, the Netherlands, showcases the possibility of FibriCheck as a monitoring tool after treatment. In this collaboration specifically, FibriCheck is being used to follow up on patients in a post-cardioversion pathway in order to detect AF recurrence and the recurrence of symptoms after treatment.

MUMC+ and Dutch health insurer VGZ lead the way for reimbursement

Employing the FibriCheck app to monitor patients’ heart rate and rhythm remotely in the TeleCheck-AF project, the Maastricht University Medical Centre+ started implementing large scale tele-consultations for many of its heart patients during the Covid-19 pandemic. Since then, this groundbreaking approach has become the standard at MUMC+ for patients suffering from AF or other supraventricular heart rhythm disorders. Not only did it help reduce the cost of healthcare at the clinic, it also increased the efficiency, making the health economic case very clear.

The positive health economic case did not escape the attention of Dutch health insurer VGZ, who in early 2022 agreed to reimburse FibriCheck. It’s an agreement that can easily be scaled to other hospitals and medical centres thanks to the Dutch Healthcare Authority (an agency of the Dutch Ministry of Health, Welfare and Sport) having honoured the agreement, making this a very important step forward for the implementation of digital healthcare.

Increasing the efficiency of the Chelsea & Westminster Hospital with virtual AF wards

With the support of our digital technology, diagnosed atrial fibrillation patients at the West Middlesex Hospital and the Chelsea & Westminster Hospital can now be discharged early. This was made possible by enhancing pre-existing AF care pathways through the implementation of an early supported discharge pathway. This pathway leverages the digital remote monitoring services of FibriCheck, combined with a digital interface linked to the patient’s electronic health record. This virtual AF ward is overseen by trained specialist nurses, who escalate to the cardiology team when needed. 

The AF virtual ward pathway significantly cuts the average length of stay by 4 days per patient, equaling approximately £1.000 direct cost savings per patient and more available beds in hospitals. The safety, feasibility, and clinical utility of the virtual ward model was also demonstrated in this setup. Patient feedback was positive overall, with 95% patient engagement with remote monitoring. This pathway can be established and scaled-up at a relatively low cost, while remaining widely accessible and applicable across NHS hospital trusts.