Digitally-enabled Atrial Fibrillation Virtual Wards

To commemorate Stroke Awareness Month, FibriCheck and Patients Know Best, alumni companies of the DigitalHealth.London Accelerator, share how their digital platforms have facilitated the implementation of Atrial Fibrillation (AF) Virtual Wards at West Middlesex Hospital and Chelsea and Westminster Hospital, enabling the remote management of patients with chronic conditions.

Overview

FibriCheck is a medically certified, clinically validated digital health solution that utilises commoditised electronics such as smartphones and wearables to make clinical pathways more efficient. Our technology enables early detection and monitoring for heart health conditions through accurate remote heart rate and heart rhythm measurements, empowering users to follow up on their symptoms, blood pressure, and weight.

Traditional pathways relying on electrocardiograms (ECG) often encounter challenges, including time-consuming processes and high financial costs. Patients also experience prolonged wait times due to limited access to necessary hardware, which poses additional health risks.

Innovative approaches like virtual wards are therefore crucial in addressing these issues to enhance accessibility, efficiency and tailor care to individual needs. It simplifies care processes, reduces expenses, tackles healthcare access disparities, and improves monitoring for patients with evolving health conditions.

Project Synopsis

Atrial Fibrillation (AF) is the most common cardiac arrhythmia, affecting around 1.4 million people in the UK. With current pressures on the NHS and healthcare system, a more efficient approach is needed to tackle workforce challenges, inpatient bed pressure and service constraints. It is estimated that effective management of AF could prevent 7,000 strokes and save over 2,000 lives annually in England alone.

FibriCheck was successfully integrated into a virtual wards project implemented across two North West London hospital sites: West Middlesex Hospital and Chelsea and Westminster Hospital. Endorsed by NHS North West London, this project leveraged digital technology to remotely manage patients with chronic conditions, utilising real-time data from our photoplethysmography (PPG) technology.

Patients Know Best (PKB) is a Personal Health Record platform designed to bring together primary, secondary and community care data as well as the patient’s data into one record. Integration enabled us to send heart rhythm reports and measurements into the patient’s PKB record which both clinician and patient could view alongside the rest of their health data providing a more holistic view of their health and care. Monitoring their patients’ measurements, alongside their other health conditions, helps clinicians know when intervention is needed. This all helps to make virtual wards possible.

73 patients diagnosed with AF were onboarded and utilised FibriCheck to monitor their heart rhythm twice daily and record symptoms, replacing traditional in-person appointments. A dedicated digital monitoring hub, managed by specialist nurses, facilitated initial contact, provided ongoing support, and conducted daily reviews of measurements in case of abnormalities. Cases requiring further attention were promptly escalated for follow-up where necessary.

The Atrial Fibrillation (AF) Virtual Ward Pathway

The following image shows how the Atrial Fibrillation (AF) virtual pathway works.

Patients eligible for the AF virtual ward are enrolled on the Patients Know Best platform and introduced to the FibriCheck app, which they must download onto their handset. Upon registration, patients are taught how to perform and record their measurements with the app. This includes a live demonstration, informational leaflets, resources, and a personalised care plan. Initial support is provided through the app’s Digital Monitoring Hub within 24 hours to address any queries or troubleshooting needs.

Once patients are comfortable with the app’s functionalities, remote monitoring begins. Patients take measurements twice daily and log any symptoms they experience on the app. This data is securely transmitted via the cloud system to the Patients Know Best dashboard for review. Clinical staff monitor patients via the Digital Monitoring Hub daily, reaching out via telephone in case of flagged abnormal parameters, missed uploads or patient inquiries. Any issues requiring escalation are promptly referred to senior clinicians to expedite clinical review or emergency admission where necessary.

Throughout the patient’s time in the AF virtual ward, weekly multidisciplinary team meetings (MDT) are held to discuss individual cases. These meetings facilitate decisions on ongoing AF management and follow-up, including additional monitoring as needed. Upon discharge approval, patients are guided toward routine or expedited follow-up appointments in specialist clinics or transitioned back to community care.

Impact/Outcomes

This project had a significant impact on workforce challenges, inpatient bed pressure, costs, and patient satisfaction. Virtual wards cut the average length of stay by four days per patient, approximately saving £1,000 in direct cost per patient and providing more available hospital beds by supporting early discharge. 

The feasibility and clinical utility of the virtual wards model was also demonstrated in this setup. Patient feedback was positive overall, with 93% patient engagement with remote monitoring and 86% of patients indicating that FibriCheck was easy to use. There were no changes in A&E admission after discharge and all 43 respondents indicated that they felt better looked after on the AF virtual ward then if they had remained as inpatients in hospital. 

This intervention facilitated the early detection of health deterioration in 9 of the 73 patients, resulting in appropriate recommendations to seek urgent medical attention or call emergency care services. Over a longer three month time span following completion of remote monitoring, only three patients re-attended with an arrhythmia-related presentation, and a clear cause can be isolated in each case. Our data demonstrates the safety and feasibility of a virtual ward model for AF care, with an overall clinical benefit for both admission avoidance and early supported discharge of inpatients.

Physician

The project also demonstrated environmental advantages, such as the decreased need for patient transportation, positively impacting carbon footprint. 

Next Steps

In light of the increasing pressure on the national health system, the NHS is actively promoting the expansion and implementation of virtual wards. These wards facilitate the early supported discharge of patients and offer alternatives to hospital admission, which can significantly enhance care outcomes and reduce healthcare expenses.

This pathway can be scaled up easily at a relatively low cost, making it widely accessible and applicable across NHS hospital trusts. 

For more information, check out the full research article at https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000475 or visit our Innovation Directory.

The DigitalHealth.London Accelerator programme is funded by the UK Government via the UK Shared Prosperity Fund (UKSPF). It is delivered by the Health Innovation Network (HIN) South London in partnership with the Office of Life Sciences, CW+, Medicity, NHS England, the Mayor of London and the Levelling Up Fund.

For more information, please visit https://www.gov.uk/government/publications/uk-
shared-prosperity-fund-prospectus.