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How an ECG machine on my phone halves appointments for heart palpitation

Dr Matthew Fay describes how being able to do an ECG with his phone reduces the appointments needed to treat patients with heart palpitation and atrial fibrillation

What we did

I am a GP partner at a practice in Bradford, so I’m in the desert when it comes to appointing practice nurses and GPs. I’m therefore keen to use anything that would reduce demand on GP and nurse time. I also like my tech, so when I heard about a device that can help my phone do ECGs I tried it out.

The device is a small monitor that fits on the back of your smartphone, and it essentially converts your phone into an ECG machine. Patients who come in with heart palpitations can hold my phone, touching the sensors, which gives me an ECG trace to determine whether they have a serious problem like atrial fibrillation.

It takes about 30 seconds, including the time to get out my phone and open the app (the actual trace takes 15 seconds). I probably use it six times a week, although this might be higher than other GPs because I have a cardiac speciality.

The cost depends on who you buy it from and whether you buy it in bulk, but the device cost me around £100, and because I love my toys I bought it myself.

Challenges

There would be information governance issues if I was carrying around patient identifiable information on my phone. However, when I do the trace on my phone it’s got no patient identifiable information. If I want to attach it to the patient record because it’s shown a pathology, we have an NHS email account which is looked after by one of our cardiovascular nurses and I get the patient’s permission to email it to that single account. When they receive it I then phone the nurse running the account to tell them which patient it is.

Also, the GPs who are using it need to have a basic understanding of how to read the ECG and many of my colleagues would say that that is not part of core general practice. But as a diagnostic tool I think it is worth the effort to pick up those basic skills and of course because there is no patient identifiable information on the trace, my colleagues in practice can always email the trace to my NHS email account and I can give them an opinion if it’s needed.

Results

It really helps to reduce the appointments for patients with atrial fibrillation.

This is because if after using the device, I see that the patient actually has sinus arrhythmia, normal speeding and slowing of the heart while they breathe, I won’t ask them to have a 12 lead ECG. So the only patients who are now being referred for a 12 lead ECG from me are patients who we’re confirming the diagnosis for.

This saves appointments because we’re making a diagnosis in a single step. I can tell the patient the diagnosis when they first come in with heart palpitations. So I don’t need to waste nurse appointments doing ECGs which aren’t going to actually help the patient’s diagnosis and they don’t have to book another appointment to see me after that test. Also, during the follow up appointment, rather than informing the patient that they’ve got AF, I can commence their anticoagulant medication and send them off to the warfarin clinic. And for those with no problem, I can reassure them that they are fine so they disappear out the system.

I reckon I’m cutting down appointments for palpitations and AF by about 50%. And these are time-consuming appointments, people are worried about these kinds of things.

The future

Several of the other GPs in our practice group, which covers five practices in Bradford, have also got some of these devices and from September this year all the clinicians of Westcliffe, so 50 different GPs and nurses, will have these devices. We’re going to do an audit looking at if that improves our pickup of AF and the experience for our patients.

Dr Matthew Fay is a GP in Bradford

The device is Kardia mobile from AliveCor. The company had no input into the copy.

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Readers' comments (23)

  • Fantastic idea!
    Love using technology to aid care and management!
    Thanks for the heads up and will certainly have a look at this.
    Michael

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  • One of our GPs is conducting a trial using the Kardia monitor and app, the patient basically places 2 fingers on each sensor for 60 seconds and it does much the same thing. We then refer them for an ECG if the tracing shows possible AF. For the trial nurses are using the monitor to detect abnormal rhythms on patients with diabetes and CVD only at the moment.

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  • This is a fantastic suggestion - thank you for sharing!! Has anyone thought of or is using the portable INR monitor (similar to a blood glucose finger prick device that gives an instant INR result) in general practice? It sounds an interesting option to consider especially for the house bound and for those who need monitoring change of medication etc.,, would have to have a clinician able to dose the warfarin but sounds much better than going through venous sampling and the Anticoag services.

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  • Seen this. No better than a sats monitor.
    Anyway. If it's only a differential between sinus arrhythmia and AF then hold the pulse. Look at a watch and count.

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  • Had one for a year now. Great little gadget. There's a 6 six lead one in the works as well.

    I'd like a study to see if they can be used for QTc interval work in psychiatry patients e.g. a CPN emails an ECG to psychiatrist etc to okay the QTc.

    Imagine the time that could save.

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  • To Julieann 8:52

    There a number Of NICE accredited devices for home / practice monitoring of INR.

    Inhealthcare Ltd offers a home monitoring service to CCGs, linking home / practice systems to DAWN / INRStar and GP systems for safe and accurate management of anticoagulation .

    Details here:

    http://www.inhealthcare.co.uk/product/inr-self-testing/

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  • I thought this was for non clinicians
    You should be able to diagnose probable AF by listening to the apex beat and then confirming with formal ECG

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  • Dear gp partner 524

    Agree this is gold standard but what about a patient with paroxysmal af. 24 he monitor or 12 lead wcg the next day may not pick this up. Also this may have the potential to reduce workload for stretched nurses and hcas

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  • Nicholas
    Thank you for the information - will take this forward.

    Best wishes

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  • Quote; GPs who are using it need to have a basic understanding of how to read the ECG and many of my colleagues would say that that is not part of core general practice.
    Good lord. Are there GPs who can't read an ECG? What? If that were true, it's really embarrassing. looks like a silly gadget. If you can't tell an irregularly irregular pulse and a suspicion of AF then it's time to leave practice.

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