AF & Stroke - Q2 2021

AF & Stroke A Mediaplanet campaign focused on

Q2 2021 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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AF-related stroke will always be a concern Atrial fibrillation (AF) can be a “silent killer” — often people with AF do not have symptoms and, therefore, are unaware that they are at risk of a devastating, and potentially fatal, stroke.

W WRITTEN BY

Trudie Lobban MBE Founder and CEO, Arrhythmia Alliance and AF Association

ithout the right anticoagulation therapies, a person with AF is five times more likely to have an AF-related stroke than someone without AF. AF-related strokes are more devastating, more disabling, and more often, prove to be fatal than other types of stroke. We need to detect AF with a simple pulse check to protect against AF-related stroke.

It could save your life.

The AF Association’s new AF White Paper — Put People First highlights that direct oral anticoagulants (DOACs) are now “firmly established” as the first-line anticoagulant therapy over and above warfarin.

Several studies suggest that DOACs are safer and more effective than warfarin and, unlike warfarin, DOACs do not require regular blood tests to ensure that a person is sufficiently anticoagulated.

While there are no substantial differences between the different types of DOACs (four are available in the UK), they do differ in terms of their dosing regimens.

Finding the best therapy for the individual The AF white paper advocates that healthcare professionals review a patient’s individual needs and wishes, ensuring that they are prescribed a therapy that best suits the individual.

It also notes that good communication between both the patient and healthcare professionals is vital to better understand the condition and adhering to the therapy regimen.

As with all medication, DOACs are only effective if they are actually taken as prescribed. They will not protect against AF-related stroke if they remain in the packet!

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Heart rhythm check at vaccine sites Obviously, you can only protect against AF-related stroke if you are able to detect AF in the first place. Unfortunately, COVID-19 restrictions — while necessary — have meant opportunities to detect AF, both in healthcare and nonhealthcare settings, have been lost.

For example, over the last year, people have delayed or even avoided seeing their doctor because of concerns regarding COVID-19.

To address these lost opportunities, we are rolling out a scheme of opportunistic pulse rhythm checks at COVID-19 vaccine centres. The pulse rhythm checks are performed either manually or with mobile digital ECG technologies, which can be sanitised between uses (making them COVID-19 safe) and do not interfere or delay the vaccine process.

Anyone found to have an irregular rhythm, or “possible AF”, is referred to their GP for further investigation. All participants are also given information and advice about AF and the need to protect against AF-related stroke.

The AF Association, with its Know Your Pulse campaign, raises awareness of the need to detect atrial fibrillation (AF) – the most common arrhythmia (heart rhythm disorder).

For more information about our detection of AF at vaccine centres, please visit: heartrhythmalliance.org/aa/uk/detection-of-af-at-vaccination-centres

Contact information: uk.info@mediaplanet.com or +44 (0) 203 642 0737

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Project Manager: Maggie Platten maggie.platten@mediaplanet.com Business Development Manager: Ciara Barker Managing Director: Alex Williams Head of Business Development: Ellie McGregor Head of Production: Kirsty Elliott Designer: Thomas Kent Digital Manager: Harvey O’Donnell Paid Media Strategist: Jonni Asfaha Production Assistant: Henry Phillips All images supplied by Gettyimages, unless otherwise specified

PUSH YOUR HEART WITHOUT FEAR World’s first and only chest-worn Smart Heart Monitor that provides high quality continuous ECG & real-time feedback on your heart health.

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How technology can help avoid secondary stroke A miniature device implanted just under the skin near the heart can help prevent a serious second stroke.

A INTERVIEW BY

Ms Jayne Mudd Nurse Consultant in Cardiac Rhythm Management, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesbrough

INTERVIEW BY

Dr Amit Kishore Consultant and Honorary Senior Lecturer in Stroke Medicine, Salford Royal NHS Foundation Trust

INTERVIEW BY

Jeanette Weschenfelder Patient WRITTEN BY Mark Nicholls

The views and opinions expressed in this article are the personal views of the author and interviewees. No interviewees were paid. This article is not a substitute for medical advice. Medtronic is not responsible for, and disclaims any and all liability for the content of this article.

ctive, fit and a regular tennis player Jeanette Weschenfelder suffered a stroke in her sleep in September 2018, yet the reasons behind it were unclear.

She had complained of an irregular heartbeat, but doctors could find nothing untoward in the weeks before her stroke, even with short-term cardiac monitoring.

But three days after her stroke, Jeanette was fitted with a tiny loop recorder implanted in her chest that would constantly monitor her heart for up to three years. It picks up any problems such as atrial fibrillation (AF) that short-term approaches - such as an ECG, 24-hour Holter monitor or patch can often miss.

Painless implant People with AF who have a stroke can suffer a second, more devastating, stroke therefore a remote monitoring device can prove crucial.

Jeanette, now 61, was well enough to travel to her daughter’s wedding a few days after leaving hospital, reassured that she was being constantly monitored.

The loop recorder confirmed she had paroxysmal or intermittent - AF and she was put on medication to control the condition and help protect her from a second stroke.

Prompt treatment Having retired as a reporting radiographer and playing tennis again, she feels that anybody suspected of AF should have a loop recorder fitted to help avoid a stroke.

“I have been lucky, I can return more or less to normal life, but not everybody is so lucky” she adds.

About 30% of patients leave hospital with the cause of their stroke undiagnosed, but if AF is detected by a loop recorder device, prompt treatment can be implemented to avoid a further stroke.

Consultant stroke physician Dr Amit Kishore has helped establish the ESUS (Embolic Stroke of Unknown Source) Clinic at Salford Royal NHS Foundation Trust in Greater Manchester. Working with colleagues in cardiology and neurology, they are treating patients where the heart is believed to be the source of the stroke.

Cost-effective approach With silent, or asymptomatic AF, which is a known stroke risk, Salford Royal identify patients at highest risk of irregular heartbeat, after a series of tests, including non-invasive monitoring prior to fitting a loop recorder. Dr Kishore expects to see a reduction of recurrent strokes as a result of the loop recorders with more patients receiving essential blood-thinning (anticoagulation) treatment.

A stroke costs the NHS £45-60,000 and severely impacts a patient’s quality of life, he says, whereas picking up the risk early via such devices can reduce strokes, cut the burden on the NHS and improve patient care. The loop recorder is quick to implant, often taking a few short minutes to actually insert, meaning the patient can just attend a short outpatient clinic appointment for it.

Paid for by Medtronic

Long-term monitoring Jayne Mudd is a nurse consultant in cardiac rhythm management at the James Cook University Hospital in Middlesbrough, working with patients with AF and other arrythmias.

The hospital, where Jeanette was treated, runs a nurse-led service which implants and explants loop recorder devices and performs long term monitoring.

She explains that the device, injected under the skin to monitor heart rhythm and detect arrythmias, offers detailed, long-term monitoring.

“Patients may have paroxysmal AF where the arrythmia comes and goes and can be difficult to detect,” she says. “This is where a longer-term monitoring device is so useful.

“Patients with AF who have had a stroke have a high chance of having a recurrent stroke, so we need to try and prevent that, as the impact of a second stroke is potentially devastating. “Diagnosis and prompt initiation of anti-coagulation therapy is vitally important. We are alerted very quickly through the remote monitoring system if the patient has any AF and can initiate anti coagulation on the same day in many cases.” Once we have a diagnosis the AF can be managed appropriately with for example medication and lifestyle changes. The device at that point can actually be removed or left in dependent on patient choice. Jeanette and other patients have fed back to us that having a loop recorder implanted provided reassurance for them.

Jeanette has now been able to go back to enjoying life after her stroke with the knowledge that she has a diagnosis and is on the correct treatment to manage the AF and to help prevent further strokes.

NICE Diagnostics Guidance 41: Reveal LINQ™ insertable cardiac monitor is recommended as an option to help to detect atrial fibrillation after cryptogenic stroke, including transient ischaemic attacks (TIA), only if: • non-invasive electrocardiogram (ECG) monitoring has been done and a cardiac arrhythmic cause of stroke is still suspected (Source: NICE Diagnostics Guidance 41: Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke. September 2020 © NICE 2020) For full access to the guidance visit: nice.org.uk/guidance/dg41/chapter/1-Recommendations

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Wearable technology is driving innovation to help better manage heart health Analysing the heart’s rhythm through wearable technology on your wrist is enabling a more accessible way to check for signs of AF.

A Spread paid for by Fitbit

Heart disease continues to be one of the leading causes of death worldwide, despite being one of the most preventable conditions.

Find out more at fitbit.com/global/ uk/technology/ecg

According to the World Health Organization, heart disease continues to be one of the leading causes of death worldwide, despite being one of the most preventable conditions.1 Atrial fibrillation (AF) is a common irregular heart rhythm and can increase the risk of serious complications like stroke.2 It affects around 1.6 million people in the UK and increases the risk of stroke by five times compared to the general population.3 Catching the condition early and treating it appropriately can prevent approximately two-thirds of AF-related strokes.4 However, estimates show that around 500,000 people are living with undiagnosed and untreated AF in the UK.5 Improving health management with technology Advancing technology is changing the way people can manage their heart health, giving them more control and enabling earlier diagnosis. Wearable devices are known for being motivational tools that track activity levels, help facilitate positive health behaviour change and have continued to evolve by now bringing technology to users that was previously accessible only in healthcare settings.

Fitbit can help assess your heart for signs of atrial fibrillation (AFib) AFib can be difficult to detect but the Fitbit ECG app lets you check in on your heart rhythm right on your wrist – so you have a better chance of spotting and treating it.

CE marked. Validated in a clinical study to provide accurate results.

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The Fitbit ECG app is only available in select countries.

Not intended for use by people under 22 years old. See fitbit.com/ecg for addition

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Wearable technology is now at the forefront of heart health management, with advanced functionality being integrated across health wearables, such as integrated sensors and ECG apps that make it accessible and easy to assess your heart for AF. Electrocardiogram (ECG) is a measurement of the electrical activity of the heart, and such apps are a simple way people can take an on-thespot reading of their heart rhythm at any time, including whenever they notice any unusual cardiac symptoms.

On-device ECG apps use the sensors on compatible smartwatches to allow the user to record the electrical signals from their heart and classify them as AF or normal sinus rhythm. The Fitbit ECG app has already received CE Marking in the EU and FDA clearance in the US. “Helping people understand and manage their heart health has always been a priority for Fitbit, and I’m incredibly excited that we are making these innovations accessible to people around the world to help them improve their heart health, prevent more serious conditions and potentially save lives,” says Eric Friedman, VP Research and Co-founder, Fitbit.

“Early detection of AF is critical, and in addition to our spot check technology using ECG, we’re advancing our AF research to also look at more continuous heart rhythm tracking using sensor technology that runs in the background, as both have important roles to play in managing potential AF.” More continuous heart rhythm tracking from photoplethysmography (PPG) technology, tracks the pulse directly from a user's wrist. This could give users the ability to identify asymptomatic AF that could otherwise go undetected. To continue to build evidence for the use of this technology,

Early detection of AF is critical, and in addition to our spot check technology using ECG, we’re advancing our AF research to also look at more continuous heart rhythm tracking using sensor technology that runs in the background, as both have important roles to play in managing potential AF. a large-scale virtual clinical trial, the Fitbit Heart Study, was conducted, and enrolled more than 455,000 participants in the US. Results from this study will be used to support regulatory submissions globally for its more continuous heart rhythm assessment.

Nicola Maxwell, Director of Fitbit Health Solutions in Europe, the Middle East and Africa says: “Since we first brought heart rate tracking to the wrist, we have continued to innovate and provide users with a deeper understanding of their heart health. By providing these powerful consumer tools, we are making it easier for the consumer to choose to share relevant data with their health care provider. With the development of this technology and our continued advancements, as well as our partnerships in the healthcare ecosystem, we are hopeful about the role Fitbit can play in the early diagnosis of AF, ultimately helping to tackle the rising rates of heart conditions in the UK." Resources 1. https://www.who.int/news-room/fact-sheets/detail/ the-top-10-causes-of-death 2. https://www.bhf.org.uk/informationsupport/conditions/ atrial-fibrillation 3. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/research/atrial-fibrillation-the-big-picture 4. https://www.bhf.org.uk/for-professionals/healthcare-professionals/blog/2019/atrial-fibrillation-finding-the-missing-300000 5. https://www.bhf.org.uk/what-we-do/newsfrom-the-bhf/news-archive/2017/may/ thousands-of-people-undiagnosed-with-irregular-heartbeat-increasing-risk-of-stroke and https:// www.bluecrestwellness.com/healthy-living/500000people-in-the-uk-have-an-undiagnosed-irregularheartbeat

WRITTEN BY

Nicola Maxwell Director, Health Solutions in Europe, the Middle East and Africa, Fitbit

WRITTEN BY

Eric Friedman VP Research and Co-founder, Fitbit

Fitbit Sense has sensors in the frame and a biosensor core Use the Fitbit ECG app and place your thumb and index finger on the corners and hold still. Takes less than 1 minute.

Open the Fitbit app to view your heart rhythm assessment and choose to share the results with your doctor This assessment can’t diagnose AFib on its own but your results can help you have a better conversation with your doctor.

nal details.

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05

Palpitation?

No problem. Technology comes to the rescue.

Technology has come a long way over the past few years and is helping provide more accurate monitoring for patients than ever before.

I

n the past, if your heart started racing it was likely by the time you had arrived at your GP’s surgery or the emergency room your palpitation would have settled. The tracing of your heart rhythm (ECG) would most likely be normal and the whole experience would have been disappointing for all concerned.

Twenty years or so ago, Holter monitors became available, where several pads could be stuck on your chest with wires connected to a recording box. This could record for a day or two but did feel rather “clunky” and would stop you from bathing as normal. Unfortunately, often the recording period was quiet with no palpitation and no diagnosis.

The need for a better approach was clear to all. Thankfully technology has now provided a range of smarter solutions.

Advancements in monitoring technology The need for a better approach was clear to all. Thankfully technology has now provided a range of smarter solutions.

Electronic watches can identify an irregular pulse and even record a simple ECG that can be sent to your doctor by email.

The NHS has recently approved further assessment of a high-tech patch that can be used for up to a week to record all your heart beats. Your smart phone can also help. There is an app that uses its camera and torch to identify whether you might have atrial fibrillation.

Research has shown that these new technologies can make a meaningful difference to finding out the reasons for palpitation and can help pick up heart rhythm problems that might have remained undiagnosed.

If something abnormal is found your doctor will want to do further tests to ensure that the diagnosis is correct and to help determine whether you need to have treatment.

Doctors have been worried that there was a risk that the “worried well” would use these new approaches to bombard them with unimportant information, such as flagging up the occasional extra beats that we all have from time-to-time. But so far, most people seem to be sensible about their use.

WRITTEN BY Professor Martin R Cowie Consultant Cardiologist, Royal Brompton Hospital, London and King’s College London

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Primary care holds the key to CVD prevention A new NHS audit is working towards delivering on the NHS Long Term Plan’s strategic ambition to prevent 150,000 strokes, heart attacks and cases of dementia.

C

ardiovascular disease (CVD) is recognised as one of the leading causes of death in the UK, exacerbated by health inequalities.

CVDPREVENT, a national audit funded

by NHS England & NHS Improvement, is being delivered to contribute to the prevention of 150,000 strokes, heart attacks and cases of dementia over the next decade, as outlined in the NHS Long Term Plan.

kind enabling a unique insight into six high risk cardiovascular disease (CVD) conditions all in one place and allowing the impact of patients having multiple conditions to be explored.

To complement the extensive data extract, a patient panel has been recruited by audit partners, The Patients Association, to ensure the voice of those with ‘lived experience’ is embedded throughout the programme.

Maximising the data Currently in its first year, What is currently available?

Workstream 3 of the audit will The audit will be a leading voice produce an initial report and in the fight against preventable interactive dashboards to help cardiovascular disease related GPs and primary care colleagues deaths. It is one of a number of The audit will be a leading in England identify priorities for resources available to primary voice in the fight against improvement in cardiovascular care, as the prevalence of high-risk disease prevention. preventable cardiovascular conditions increases and health The NHS Benchmarking Network inequalities widen. disease related deaths. are working collaboratively with Other tools include: STP CVD Public Health England to produce Prevention packs, published by a series of outputs that will identify inequalities Public Health England, NHS RightCare CVD packs in identification and management of CVD high and National Cardiovascular Intelligence Network risk conditions and variation between different (NCVIN) resources. areas of England.

News and updates from CVDPREVENT Workstream 3 will be shared via #CVDPREVENT A unique insight throughout the course of the audit.

Holding over 15 million patient records, and over 1 billion data items, this is the first audit of its

WRITTEN BY Dr Peter Green CVDPREVENT Workstream 3 Clinical Lead

WRITTEN BY Lorraine Oldridge National Lead for National Cardiovascular Intelligence Network (NCVIN), Public Health England

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Paid for by Phenox

Configuring 24-hour stroke thrombectomy services to save more patient lives The chances of getting access to mechanical thrombectomy, Clodagh Dunlop feels, was ‘like winning the lottery’. Clodagh now wants stroke patients across the UK to have equal 24-hour access to the procedure that saved her life.

M

y stroke was so massive that without a thrombectomy I’d have died,” says Clodagh, a police detective from Northern Ireland, who had a stroke in 2015 aged just 35.

“I owe my life to the specialist team from the Royal Hospital Belfast who cut short their Easter break to save me with a novel procedure.”

Now a thrombectomy, which involves the removal of clots blocking blood vessels in the brain with a stent retriever to provide immediate blood flow, has become mainstream. “It’s a game changer.

Research shows you need to treat fewer than three stroke patients with a mechanical thrombectomy to save one person from being left with severe disability,” explains Dr Peter Keston, a neuroradiologist from NHS Lothian, Edinburgh.

Major service reconfiguration But to translate the NHS Long Term Plan’s ambition to deliver a tenfold increase in patients receiving thrombectomy by 2022, stroke services across the UK need to undergo major reconfiguration.

Estimates suggest the number of interventional neuroradiologists needs to increase to almost 150.

Such levels are required to ensure services are staffed 24 hours a day, seven days a week because strokes (as in the case of Clodagh who had her stroke around midnight) do not occur conveniently during office hours.

Other issues include establishing a robust network of neuroscience centres (where a thrombectomy is delivered) and ensuring centres get sufficient patient volumes to guarantee continued expertise.

Clodagh was lucky to be in Belfast

when her stroke happened. For millions of people in the UK if they have a stroke, they will not receive a mechanical thrombectomy, simply due to geographical location. Receiving a mechanical thrombectomy could mean walking out of the hospital a couple of days later. Not receiving the service could mean never being functionally independent again, or worse.

Timely referrals are the key to more successful mechanical thrombectomies. Referring a patient to a thrombectomy centre more than six hours after their stroke onset is significantly reducing that patient’s chance of recovery and for some, survival. “Witnessing a mechanical thrombectomy is inexplicably moving because of the immediate visible recovery of the patient” explains Áine Murphy, International Marketing Manager, Acute Ischemic Stroke, Phenox GmbH. Neurointervention is an innovative field of medicine and for the teams involved in delivering mechanical thrombectomies it is more than just a job.

Research shows you need to treat fewer than three stroke patients with a mechanical thrombectomy to save one person from being left with severe disability.

A&E staff need help identifying candidates Fundamental to the success of any future service will be the ability of A&E to identify the 10% of ischaemic stroke patients suitable for thrombectomy.

Clodagh is all too aware that she would never have been transferred to the specialist neuroscience centre without quick thinking of A&E doctors who spotted her suitability.

Clodagh sees her experience as illustrating the need for thrombectomy services to be available 24 hours a day, seven days a week. With shorter time delays, she believes she would have suffered less long-term disability.

“Yes, I’m grateful to be alive, but due to the 10-hour delay in receiving treatment large parts of my brain have died,” says Clodagh who has lost function in her right arm, needs a splint to walk, and struggles with swallowing. “On the positive side I’m back working full-time and have retrained to be a detective when I could no longer get out on the beat. It’s all about focusing on what I can do and learning how to do things differently.”

INTERVIEW WITH Áine Murphy International Marketing Manager, Acute Ischemic Stroke, Phenox GmbH

INTERVIEW WITH Clodagh Dunlop Stroke Survivor, PSNI Police Officer

INTERVIEW WITH Dr Peter Keston Lead Consultant Neuroradiologist, NHS Lothian WRITTEN BY Janet Fricker

Phenox UK are not only building products, but they are also passionate about the delivery of mechanical thrombectomy to stroke patients in the UK. To put this into action, they are collaborating with the neurointerventional departments to provide imaging training courses to improve speed and consistency of referrals to thrombectomy centres. Find out more at phenox.net/international

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07

Athlete Paula Radcliffe shares how wearable technology has helped her and her mother manage their heart health

©Image provided by Paula Radcliffe

Paid for by Fourth Frontier

Technology can provide peace of mind for your heart The years 2020-21 will go down in history for many reasons - most of them related to COVID-19. However, the pandemic has had spill over effects on people with other ailments as well, particularly cardiovascular disease.

I BASED ON AN INTERVIEW WITH Paula Radcliffe Athlete WRITTEN BY Peter Joseph

08

n the summer of 2020, when the pandemic had just the pandemic she couldn’t see her cardiologist. She suffered started, there were many news reports across the world, a huge amount of stress when we lost my father suddenly which asked “where have all the heart attacks and and had to spend a lot of time alone. Her symptoms flared strokes gone?” and she was concerned.

The picture that later emerged showed that many people “She had already been using the Frontier X smart health could not visit their doctors in a timely manner due to the monitor, in the absence of face to face meetings, she was lockdown. As a result, they ended up in also able to share all her data and ECG the emergency room only when they had a recordings with her cardiologist. This has debilitating stroke or heart attack. given her immense peace of mind, because It now appears that many of these deaths the device tells her the percentage of time could have been avoided if patients had that she spends in AF and also records It now appears that many of access to the latest technology to monitor particular events where she felt symptoms, these deaths could have been their cardiovascular health at home. so that her medical team can look at it later. avoided if patients had access “She has also enrolled herself onto the to the latest technology to Monitoring heart health at home cardiac fitness service where she can speak Paula Radcliffe, former World-record holder monitor their cardiovascular to a cardiac rehab specialist every week for the full marathon, who now supports who reviews her data and guides her on her health at home. health initiatives to combat cardiovascular exercise regimen. She is planning a walking disease, manages to stay on top of her own retreat with her friends this August.” and her family’s health with the help of wearable technology.

Paula also says that the technology helped her monitor her “My mother has suffered from atrial fibrillation for a long own cardiac health as she recovered from COVID-19 in March time, but still leads a very active life at the age of 73”, says 2021. She believes that such devices will be a norm in the Paula. “In July of 2019, my mother suddenly started feeling future, as people take greater control of their own health. some symptoms during her bike rides she underwent two cardioversion and her condition stabilised. However, during

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