POPULATION HEALTH AND AWARENESS
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.
TARGETED AF DETECTION
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.
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.
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.
ALIGNMENT TO USUAL CARE PATHWAYS
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 NHS Foundation Trust 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 whilst providing additional support in the community, 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.
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.
Demonstrating the power of digital transformation in healthcare
Objective: To ensure continuity of care for patients during the COVID-19 pandemic through TeleCheck-AF: a remote monitoring teleconsultation approach powered by FibriCheck, in collaboration with clinics across Europe.
Project outline: The pandemic has placed tremendous pressure on healthcare professionals to provide care safely and efficiently. Moreover, restrictions on face-to-face consultations and reallocation of resources in many hospitals made it extremely difficult for many patients with pre-existing conditions to access timely care. The Europe-wide TeleCheck-AF project was subsequently developed by FibriCheck in close collaboration with clinician-scientist Dr. Dominik Linz MD and Biosense Webster in order to provide an efficient, effective and scalable pathway approach that could be easily adopted and replicated in multiple clinics. Providing a safe and convenient solution for patients, and an efficient source of reliable real-time data for physician decision making.
Conclusion: Implemented in over 40 clinics across Europe and reaching a total of 3,253 heart patients, TeleCheck-AF is a powerful demonstration of digital transformation in delivering high quality patient care while reducing the burden on healthcare systems. Especially in cardiology practices with cancelled or delayed care pathways, TeleCheck-AF proved the efficacy of FibriCheck in supporting ongoing treatment via remote monitoring. Participating centres and their patients were highly satisfied with the at-home offering and data capability, powered and backed by FibriCheck’s compliant cloud infrastructure. Moreover, given that more than half of the AF episodes detected by the FibriCheck app were asymptomatic, the project also clearly demonstrates the added value of the solution in general diagnostic pathways, post the pandemic and beyond. The majority of participating centres predict that mHealth approaches such as TeleCheck-AF will continue to be used for the follow-up and management of patients, e.g. post AF ablation. Overall, the efficacy, efficiency, scalability and reliability of the TeleCheck-AF approach makes it an effective alternative and/or supplement to traditional face-to-face consultations, as reflected by the changes many European centres have made to their current standard of practice guidelines.
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.
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.
Enabling a holistic view of health data for both patients and providers
Project outline: A clear example of how FibriCheck’s API can be easily integrated with partner platforms like patient-driven health platform Patients Know Best.
Project outline: Having recognised the value in both FibriCheck and PKB in practice, Chelsea and Westminster Hospital NHS Foundation Trust wanted to maximise the potential of both solutions in order to transform the way they follow up on their patients. Owing to FibriCheck’s various integration possibilities, it was clear for the Trust that facilitating the connection between their patients’ FibriCheck data and their PKB record would not only support clinical decision making around Early Supported Discharge and ambulatory care, but also offer patients peace of mind.
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.
Enhancing access to telehealth services in the MENA region via an innovative integrated solution
Project outline: Following a successful integration path, FibriCheck and AlTibbi have created an integrated solution that combines FibriCheck’s remote heart rhythm detection and monitoring capabilities with AlTibbi’s region-wide platform. Users of the AlTibbi app are able to perform measurements of their heart rhythm and consult FibriCheck reports without having to exit the AlTibbi app.
Through this new integrated program, the partnership – which also includes Pfizer – is now launching a large-scale targeted case finding program that aims to identify 100,000 individuals in the United Arab Emirates to not only detect disorders such as atrial fibrillation, but also to provide patients with the appropriate medical content and telehealth services they may need as a result.
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.
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.