Introduction: Atrial Fibrillation Association (AFA) recognised there was a prime opportunity to detect AF during COVID-19 vaccination clinics by offering heart rhythm checks. European Society of Cardiology (ESC) recent guidelines recommends single-lead ECG for detection and diagnosis of AF (class one recommendation). AFA-trained volunteers and healthcare professionals established a fluent pathway.
Concept: AFA in collaboration with two GP surgeries in West Suffolk developed a pathway which attracted clinical support.
• People receiving a COVID-19 vaccination consented for a single-lead ECG (AliveCor Kardia) for a heart rhythm check
• Everyone was provided with AFA’s “Know your Pulse” plus “What is AF?” information leaflets
• Those detected to have “possible AF” were signposted to their clinician with a copy of their ECG and an AFA explanatory letter
Pilot: Adhering to strict “COVID-19 safe” protocol, heart rhythm checks in a cohort of one hundred 60 to 64 year olds detected two “possible AF” results which were reviewed by their GP. At no point did it disrupt or delay the delivery of vaccinations.
Roll-out deployment: Following the success of the pilot, we expanded the detection of AF to additional GP surgeries concentrating on 80+-year olds using AFA-trained volunteers.
Results
People with previously undiagonised AF yet detected with ‘possible AF’ using AliveCor Kardia were seen in-person or virtually by their GP within 48 hours. Clinically appropriate anticoagulation therapy and rate-limiting medication was prescribed. These results gained with single-lead ECG provided significantly greater yield than those found in a South of England COVID-19 vaccination setting where opportunistic pulse palpation (NICE guidance 2014 and repeated April 2021) undertaken by a clinician yielded only 8 ‘possible AF’ in a cohort of 2,000.
Conclusion: The use of single-lead ECG (AliveCor Kardia) by AFA-trained volunteers in COVID-19 vaccination clinics proved highly successful in detecting ‘possible AF’, supporting Public Health England’s Long Term Plan by detecting and diagnosing AF thus reducing AF-related strokes. A significantly greater yield was achieved than pulse palpation undertaken elsewhere in spite of the advice re-issued in the new NICE AF versus ESC guidelines. This approach could be rolled out across the NHS saving lives and saving money.
