Detecting and managing atrial fibrillation

Brain scan image: Detecting and managing atrial fibrillation

The ‘Podiatry and Atrial Fibrillation – Save a life, stop a stroke’ webinar was created to improve the detection and management of atrial fibrillation, and it’s already saving lives.

A three-month pilot foot pulse-checking project aimed at increasing the
diagnosis of atrial fibrillation (AF) and created by a partnership of NHS bodies and industry, successfully identified a number of patients with previously undiagnosed AF.

Conducted by County Durham and Darlington NHS Foundation Trust, the work is part of a wider AF Programme run by the Academic Health Science Network for the North East and North Cumbria (AHSN NENC) in conjunction with the Northern England Clinical Networks. It aims to reduce the number of strokes and deaths in the region by treating AF as early as possible.

“The work means patients with previously unknown AF can be detected and treated to prevent a stroke”

As part of this work, medical education and events company E4H, in partnership with the AHSN, London Clinical Network, voluntary sector and NHS England, created a series of educational webinars, ‘Podiatry and Atrial Fibrillation – Save a life, stop a stroke’, to which 407 people tuned in. Martin Fox FFPM RCPS (Glasg), FCPM, Vascular Specialist Podiatrist, chaired the webinar, accompanied by speaker, Advanced Podiatrist Linda Hicks. During the Q&A they were joined by Kate Mackay, Atrial Fibrillation Programme Lead at the AHSN NENC and Co-ordinator, Northern Diabetes Footcare Network.

Optimising treatment

Kate Mackay led and developed a programme of projects to ensure those with undetected AF are found and to optimise treatment of patients with known AF, with the aim of reducing AF-related stroke and mortality.

Kate developed a multi-professional AF Steering Group representative of the AHSN’s geographical footprint, consisting of local leaders from within the AF community including the NHS, third sector and commercial partners.

The pilot work involved podiatrists checking patients that were having a diabetes foot check. It was initiated through existing relationships between Kate and Linda Hicks, Advanced Podiatrist, Podiatry Department, County Durham and Darlington NHS Foundation Trust.

Kate was looking for ways to detect patients with an irregular pulse, particularly where patients are already being seen by a healthcare professional, while Linda was aware that patients with diabetes are at greater risk of cardiovascular disease. Both knew that patients attending for their diabetes annual review have their feet checked, and this included a check on their foot pulses.

Podiatrists are not usually listening to a pulse for regularity, so with a bit of extra training the podiatry team started to listen for regularity and referred any patients with an irregular pulse, and not known to have AF, to their GP for a 12-Lead ECG to confirm or refute a diagnosis of AF. Both Kate and Linda also sit on the Northern Diabetes Footcare Network and this enabled the spread and adoption of the work, post-pilot, to other podiatry teams in the North East and North Cumbria area.

The work has not been onerous for podiatrists or GPs and means patients with previously unknown AF can be detected and treated to prevent a stroke.

Anecdotally, South Tees Arrhythmia Team contacted Kate to tell her that every patient in one of their morning clinics had been referred via a podiatrist, and five of the six patients were found to have AF. The work continues to be adapted with the majority of areas in the North East and North Cumbria now adopting this work.

Case study

Linda Hicks shares this case study of a patient: A 57-year-old male was diagnosed with Type 2 diabetes in June 2017. He also has hypertension which he is on medication for.
As part of the annual review, the patient was seen by the foot care technician in the GP surgery. His pedal pulses were manually palpated and the quality and regularity was checked using a hand held Doppler. The technician noted an irregularity when checking his left dorsalis pedis. She liaised with the practice nurse who arranged a 12-lead ECG there and then. The GP reviewed the result and diagnosed AF. The patient was started on warfarin the following day.

Had the patient not been diagnosed with AF he could have potentially suffered a devastating stoke which could have left him with a life changing disability or could have been fatal. Had he been driving his lorry and had a stroke, the potential damage to him and other road users could have been devastating.

The benefit of the foot checks being carried out in the GP practice shows how quickly a potential diagnosis can be made, and treatment commenced straight away.

A life saved

Registered Podiatrist Clair Sparkes runs a podiatry practice in the New Forest. Following her attendance at the webinar, Clair immediately made sure that she Doppler’d every patient. While almost every patient knew of their AF status, one didn’t. “His nocturnal leg pain alerted me to a problem and although the GP was unable to detect it, the ECG did!” says Clair. “I am very grateful to you for hosting this webinar.”

The anonymous patient wrote to Clair to thank her:

‘It has now been confirmed that I do have an atrial fibrillation and I have been prescribed some medication immediately. Obviously this is bad news, but I have to thank you very much.

‘This problem has only been found because of your attentive listening to my symptoms, your knowledge and understanding, and your prompt action. I very much appreciate that your exemplary standard of professionalism has resulted in the discovery of a very serious condition which requires urgent treatment.

‘I’m only beginning to realise what this means. I wouldn’t have the chance I now have without you.

‘Thank you Clair.’

Go to www.ahsn-nenc.org.ukwww.events4healthcare.com/preventing-af-related-strokes and www.E4H.co.uk

1. The Stroke Association, quoting The Lancet and SSNAP
2. The Stroke Association quoting Annals of Medicine