NHSX AI Award at 1: reflections and observations in cardiac monitoring
The NHSX AI in Health and Care Award – designed to fund and integrate the most innovative AI solutions into the NHS – is approaching its first anniversary of operation. This milestone feels like a good time to hear from the sites benefitting from iRhythm’s Zio service, one of the first Award winners.
The historical issue
If a cardiologist from 25 years ago found themselves transported to the modern day, they would probably find most technological developments overwhelming. Put that cardiologist into an NHS cardiology clinic, and when they see the 24-hour tapes and the cumbersome external monitors with ECG leads stuck to patients, they would feel right at home.
Professor Jay Wright, who is the lead clinician for heart failure and cardiac devices at Liverpool Heart and Chest Hospital (LHCH), is someone who might well have known this hypothetical cardiologist from 25 years ago. Having worked in the NHS for 30 years, he knows better than most that the technology cardiologists have relied upon has remained virtually unchanged during this period.
“There really has been a need for a massive overhaul of this clinical area”, Wright explains, detailing that ambulatory cardiac monitoring remains a big clinical challenge. Given that there is an obvious need to make the diagnoses quickly and accurately, Wright highlights that the ECG monitors that have historically been used only provide “short duration monitoring of relatively low quality and very low yield.”
The frustrations that cardiologists have had with the traditional ECG monitors are clear. These were devices that patients hated, as they found it difficult “to exist” while wearing the monitor. They often provided inaccurate or inconclusive results because 24 hours is too short a monitoring period in many cases. This has led to patients needing repeat testing and waiting significant periods of time before they have a definitive diagnosis.
Given how important speedy diagnosis and treatment is for cardiovascular disease, which is still the leading cause of death in the UK, change was clearly needed to reduce waiting times, beat the backlog, and improve patient outcomes. Thanks to support for iRhythm Technologies’ Zio service from NHSX AI in Health and Care Awards, this clinical need is now being addressed in LHCH and several other hospitals across the UK.
Impact of Zio by iRhythm
iRhythm is a digital healthcare company developing new ways cardiac arrhythmias are clinically diagnosed, which is why NHSX entrusted the company to lead the delivery of this project. It combines a discreet and wearable biosensor device worn for up to 14 days and cloud-based data analytics with powerful proprietary AI algorithms. The result is faster, presents more accurate diagnoses of arrythmias, and a better patient experience as the ECG device, the Zio XT, is comfortable, discreet and can be worn when showering, sleeping, and exercising.
Several NHS Trusts have been using iRhythm’s Zio XT service in their clinical practices over the past year and the feedback has so far been extremely positive. This can be broken down into the following areas:
Workflows
Multiple clinicians commented on how the Zio XT had improved their internal workflows to reach diagnosis.
Dr Zoltan Borbas, consultant cardiologist at LHCH highlighted how the reporting had helped his practices. Although admitting there was a “learning curve to it”, he found that overall and relative to alternative ECG monitoring options, it’s “excellent, much easier, quicker and better than the previous format.” He particularly focussed on the overview of symptomatic correlation and how you could quickly see whether extra beats were coinciding with patient symptoms or not.
Borbas concluded: “It makes my workflows so much easier and faster. I have already saved a lot of unnecessary clinic appointments and was able to make decisions very quickly based on the Zio report.”
Professor Wright similarly agreed that the Zio XT had improved workflows, noting that they get the results back in a nice format that doesn’t require him to scroll through hundreds and hundreds of pages of ECG traces.
Accuracy
Professor Wright also highlighted how the Zio XT had produced more accurate diagnoses. Commenting on the fact that patients are monitored for up to 14 days instead of the traditional 24 hours, he said: “Prolonged monitoring enables us to pick up more symptomatic episodes, more abnormalities on rhythm, and the pickup rate is much higher.”
Dr Joe Mills, cardiologist at LHCH agreed that the Zio XT had made marked improvements on diagnoses.
He added: “It’s made a big impact already in terms of getting appropriate monitoring out of our patients and yielding some early important outcomes that can change clinical management.”
Backlog
With fears that the patient backlog could rise to 13 million patients in the coming months, it is not an exaggeration to say it’s possibly the greatest single challenge facing the NHS’ long-term sustainability. During the past year, Tony Shannon, non-invasive lead cardiac physiologist at LHCH, noted that: “Without the assistance of iRhythm, the patient wait times at LHCH could have been anywhere up to 20 weeks.” The introduction of the Zio XT service helped reduce waiting times dramatically, with a reduction from eight weeks to about one week.
What next?
The big question facing the NHSX AI Award sites is how to fund these innovations once the Award concludes. Currently there is uncertainty about the long-term funding for these projects, which is causing concern for the clinicians who are growing to rely on these innovations to offer improved levels of patient care.
For Professor Wright, there were concerns about how patients would react to reverting to how it used to be done: “I think I would find it really hard to go back now. Some of my patients have really liked the monitors because they’ve been picking stuff up that we’ve failed with on a few occasions on 24-hour tapes.”
Despite there being uncertainty on this issue, Dame Barbara Hakin, former deputy chief executive of NHS England, painted an optimistic picture for the future.
She said: “If the evidence is really mounting that this is better for patients and better for the NHS, then people will find a way to get that national oversight through more quickly.”
Over the next few months, decisions will have to be made within the NHS to work out the long-term funding mechanism to support the most successful AI innovations. What is certain though, is that the iRhythm project across these NHS Trusts is already looking to achieve the Award’s primary objectives to improve NHS workflows and patient outcomes.