Improving health outcomes: Where now for cardiology?

Following a roundtable discussion held in 2021 with Liverpool Heart and Chest Hospital, iRhythm heard from NHS sites in East Kent, Barts and North Bristol about Zio’s impact, and what the future looks like for their trusts beyond the conclusion of the AI in Health and Care Award.

In September 2020, iRhythm Technologies was named as a winner of the NHSX (now the NHS Transformation Directorate) AI Award, enabling the digital healthcare company to trial its Zio service at scale across a range of selected trusts in England.

Before Zio’s implementation, Holter monitors were the ‘norm’ for monitoring suspected arrythmias and heart conditions. These can be viewed as outdated, burdensome, and noticeable due to their size and the need to have wires connected to electrodes. The short testing period typically seen with a Holter (24-48 hours), and low patient compliance had also led to concerns about accuracy, leading to repeat testing, or even misdiagnosis. This demonstrated a need for change within the health landscape, especially for those patients requiring longer monitoring periods.

Implementing innovative technologies within the health sector doesn’t come without its challenges, especially when it also means redesigning patient pathways. Each site worked closely with iRhythm to ensure the transition from traditional Holter monitors to Zio has been as seamless as possible, whilst considering the needs of clinicians and patients alike.

Clinician workflows

During iRhythm’s recent roundtable with the sites it currently operates in, a common theme amongst clinicians was the time-savings that Zio has allowed. Releasing resource and capacity has enabled clinical teams to focus on all aspects of their day-to-day work.

Speaking about the data that her hospital has collected to date, Mellissa Baker, lead physiologist at East Kent Hospitals University NHS Foundation Trust, mentioned they have “definitely seen reductions in waiting times for monitoring, fitting, and analysis, and its stroke service has seen an overall RTT pathway reduction.” In turn, this has created “quite a lot of time saved”, “when looking at the 3,000 patients they’ve seen so far.”

East Kent has been working through its waiting list of patients with suspected cardiovascular conditions, ensuring there is a distinct lack of ambiguity when it comes to actions required to understand their condition.

Accuracy

Zio is worn by patients for up to 14 days and analyses the vast amount of data collected over that period using an AI-powered algorithm. Longer monitoring provides a more comprehensive picture of a patients’ heart rhythm, which was particularly seen by Barts Health NHS Trust.

The Trust’s consultant stroke physician, Ollie Spooner, mentioned that “96% of its two weeks recording was analysable,” which was the same in the more functionally impaired group, and that “repeat testing for inconclusive results overall, was only 1%.”

Challenges

Getting to grips with new technology isn’t always a straight-forward process, and this has been experienced at times by the sites’ staff. Suzanne Hatfield, physiology manager at North Bristol NHS Trust, agreed that behind the scenes, although the implementation of Zio did improve workflow efficiencies and reduce the burden on clinicians’ time, it did create more administrative work for themselves.

Hatfield explained that, in some instances, the Trust had some enquiries from patients about what they could or couldn’t do while wearing the device. However, Mel Baker from East Kent acknowledged that, as Zio becomes more commonplace these administrative processes will become smoother.

What next for Zio?

As the AI Award draws to a close later this year, these sites are using up their remaining Zio devices.

The effectiveness of Zio in detecting cardiac arrythmias more accurately and at the first time of asking has been proven by the positive patient outcomes experienced across sites. So that sites have sufficient resource to prioritise all aspects of their day-to-day work, iRhythm is supporting them with their conversations with local commissioners, as they look to submit business cases for longer-term commissioning.

Various trusts, such as North Bristol NHS Trust, outlined during the recent roundtable discussion their concerns about what a delay to long-term commissioning could mean for their workflows. Hatfield said: “The waiting list was horrendous before we were able to send so many Zio devices out to patients, and I’m worried that 24-hour monitor numbers will go back up if the Trust runs out of Zio devices to send to patients.”

Hatfield has shown her concern associated with returning to the previous way the Trust operated. According to 2020 research from Public Health England, approximately 2.4% of residents that live in the NHS Bristol, North Somerset and South Gloucestershire CCG are estimated to have atrial fibrillation.

North Bristol is one of numerous trial sites concerned with what the future will look like for their cardiology departments. Decisions will need to be made – at local commissioning perspective and at the national level – about how patients with suspected cardiac arrythmias can be best supported moving forward.