Atrial fibrillation and normal or abnormal heart rate rythm concept as a cardiac disorder as a human organ with healthy and unhealthy ecg monitoring in a 3D illustration style to illustrate sudden cardiac death
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Supermarket carts could help diagnose atrial fibrillation (AF), according to research presented at a scientific meeting today.

A single lead electrocardiogram (ECG) sensor in cart handles was able to identify the cardiac arrhythmia in 39 shoppers previously unaware they had the condition.

The findings were presented this afternoon in Scotland at the annual conference of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

“This study shows the potential of taking health checks to the masses without disrupting daily routines,” said researcher Professor Ian Jones, PhD, a senior cardiac nurse and academic from Liverpool John Moores University in the U.K.

He added: “Checking for atrial fibrillation while people do their regular shopping holds promise for preventing strokes and saving lives.”

Atrial fibrillation is the most common heart rhythm disorder and is present in 40 million people worldwide. It is increasing in prevalence and associated with an increased risk of death, stroke, heart failure and cognitive decline.

In the SHOPS-AF study, Jones and colleagues placed ten carts with handles containing a MyDiagnostick ECG sensor at four supermarkets with pharmacies in the city of Liverpool for two months.

Shoppers using the modified carts were asked to hold the handlebar for at least 60 seconds. If the sensor turned green it did not detect an irregular heartbeat, after which a researcher manually checked the shopper’s pulse to assess its regularity and rule out AF.

If the sensor turned red, then an irregular heartbeat was detected, and the in-store pharmacist did a manual pulse check and another sensor reading was taken using a standalone bar unattached to a cart while the shopper was standing still.

The study cardiologist reviewed the ECG recordings of participants who either had a red light or an irregular pulse.Participants were told that there was either no AF, an unclear ECG with an invitation to repeat the measurement or confirmed AF and a cardiologist appointment within the next two weeks.

Among 2155 adults who used a shopping cart, ECG data were available for 220 participants who were identified with possible AF by virtue of either a red sensor light or an irregular pulse. After ECGs were reviewed by the study cardiologist, AF was diagnosed in 59 shoppers, with no evidence of AF in a further 115 shoppers and 46 recordings unclear.

The average age of those with AF was 74 years, 43% were women, and 20 already knew they had the arrhythmia. Thirty-nine shoppers were previously undiagnosed, resulting in a yield of 1.8%.

Further research to determine the accuracy of screening suggested there was a high rate of false positives, with only between a quarter to a half of the  shoppers who were flagged with AF through the sensor or manual pulse check actually having the condition.

The negative predictive value indicated that around half of actual AF cases would be missed.

The team nonetheless suggests that supermarkets with immediate access to healthcare professionals could provide a fertile ground for AF screening.

“Nearly two-thirds of the shoppers we approached were happy to use a trolley, and the vast majority of those who declined were in a rush rather than wary of being monitored,” said Jones.

He added: “A crucial aspect is providing immediate access to a health professional who can explain the findings and refer patients on for confirmatory tests and medication if needed.”

The researchers plan some adjustments before undertaking further study to ensure the system is more accurate. These include a designated position on the bar to hold onto, as hand movement interfered with the readings.

As European Society of Cardiology Guidelines only require a 30-second ECG for AF diagnosis, they also aim to find a sensor that will halve the length of time that shoppers need to hold the handle continuously.

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