Process Evaluation for Technology Enabled Atrial Fibrillation Screening after a Stroke in Scotland
Diagnosis of Atrial Fibrillation (AF) after stroke is a national priority.
AF-related strokes typically cost twice as much to manage as non-AF related strokes (Miller et al, 2005). If diagnosed with AF, further stroke can be reduced by 60% by taking medications such as anticoagulants. Because AF can be paroxysmal- that is the heart can go in and out of AF- it is not always detected during hospitalisation for stroke. If there is a reasonable suspicion that stroke may have resulted from undetected AF, guidelines recommend screening with a Holter monitor - an ambulatory electrocardiogram (ECG) applied in a hospital clinic for 72 hours.
A ‘Test of Change’ within one local hospital in Scotland (NHS Lanarkshire) was conducted during 2019 where a new managed service involving devices (applied to n=64 patients) were considered for AF screening that would allow for up to 14 days of continuous monitoring in the home setting.
This new technology enabled service also included reporting conducted by the company providing the service as a proposed alternative to clinicians inside the NHS doing all the report reading and analysis. Clinicians and other key implementers involved in the planning, set up, delivery, and evaluation of this service innovation were interviewed throughout the project to gather qualitative data on the potential barriers and facilitators to this type of service working longer term locally for them and or potentially scaling nationally.
Patient experience was also captured through interviews with a sample of patients who received the new service (8/64; 12.5%) to capture acceptability of the new device and resulting service within this NHS setting.
Findings revealed that patients found the new monitoring device acceptable. Stroke clinicians and nurses invested additional time in training (4 half days) to use the software, apply the devices and in home-visits to apply devices but also highly valued the availability of 14 days of continuous data.
For further adoption of this type of service, it is critical to explore whether clinicians would adopt a system or service that produces the reports for them or whether they would prefer to have the reports generated by NHS staff (trust and control versus cost and capacity for reporting).
It is anticipated that this report will benefit policy makers in government, operational managers, clinical leads, service managers and digital and IT managers and leads and many others by providing key barriers and facilitators and therefore a realistic checklist of what must be considered in planning for implementation of new technology enabled services to monitor for intermittent AF within a care pathway.