A recent webinar hosted by HSJ, in collaboration with iRhythm Technologies, focused on the challenges of diagnosing arrhythmias. The discussion highlighted the potential of artificial intelligence (AI) to improve diagnostic processes and emphasized the importance of building patient trust.
Trudie Lobban, founder and CEO of the Arrhythmia Alliance, shared her insights on the often frustrating diagnostic journey for patients with heart rhythm disturbances. She noted that this pathway frequently leads to feelings of “frustration, despair, and irritation” for both patients and their families.
In the UK, over 2 million people are estimated to have arrhythmia, with 1.4 million suffering from atrial fibrillation (AF).
This condition is characterized by an irregular and often rapid heartbeat, increasing the risk of stroke. Diagnosis typically involves an electrocardiogram (ECG), but patients often face long waiting times, and many clinics are operating at full capacity. The situation is complicated further by the fact that some individuals experience only intermittent AF.
Lobban recounted the common sentiments expressed by patients: “I’m breathless, I’m exhausted, my heart is racing, it’s leaping around, it’s like a bag of worms in my chest, it’s like the beating of drums, but every time I go to my doctor, it seems to be okay. What can I do?”
The webinar aimed to address this question, not only for patients presenting symptoms in primary care but also for those who discover a potential rhythm disturbance only after experiencing a stroke. The discussion centered on whether new technologies, including AI, could enhance diagnostic accuracy.
The event underscored that concerns about the current diagnostic processes extend beyond patients. Saeedur Rahman, a consultant physician in acute and stroke medicine at Dartford and Gravesham Trust, expressed the shared frustration among healthcare professionals. He stated, “If you imagine that you’ve told someone they have had a stroke and it could be related to AF, and they’re just waiting for the right diagnostics, it plays on their mind, and it’s a huge anxiety for them.”
Rahman highlighted the significant delays in the diagnostic pathway, which complicate timely investigations and result reviews. In 2021, he and his colleagues at the trust reviewed the process for stroke patients requiring cardiac rhythm monitoring. They found that some patients were undergoing prolonged monitoring unnecessarily, while others needed longer monitoring periods to detect intermittent rhythm disturbances.
The team concluded that an intermediate monitoring duration was necessary—longer than the typical 24-hour monitoring but less invasive than implantable loop recorders, which are designed for long-term use.
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They introduced an adhesive cardiac monitor that can be worn for up to 14 days, used under strict criteria for patients whose stroke causes remain unidentified, with a suspicion of AF. Rahman noted, “Our pick-up rate [of AF] with these monitors is ranging between 10 and 12 percent, compared to a [24-hour] Holter monitor, where it’s less than 2 percent.”
Extended monitoring provides more data for clinicians to analyze, and technology plays a crucial role in managing this data. Jennifer Weller, director of customer experience and service implementation at iRhythm Technologies, explained that the device records continuously for up to 14 days. “If we were to put it into a traditional system and analyze it, it would take a very long time,” she said.
Weller continued, “We have an advanced AI algorithm that uses deep learning to perform the first pass of analysis on that data. It’s an expert-level algorithm. The data goes through the AI algorithm, then it goes to our team of cardiac physiologists, making it much more efficient for them to work through that data. The AI enables us to analyze it quickly, ensuring that we get that data back to doctors promptly so they can make the right decisions.”
While the panelists acknowledged that technological innovations could enhance arrhythmia diagnostic pathways, they stressed the necessity of full patient engagement. David Thorne, director of transformation at Well Up North Primary Care Network, emphasized the need for patient-enabled and clinically managed approaches. He is focused on how digital technology can bring care closer to home and is exploring the introduction of iRhythm technology in primary care settings.
Thorne noted, “Clinicians in primary care are always worried that if you change a pathway, it will mean that they now do more work that used to be in hospitals. But we think when we sketch this pathway out, it makes it easier for GPs and practice nurses to get results.”
Lobban expressed optimism that revising diagnostic pathways could alleviate the frequent challenges patients face.
However, she stressed the importance of building trust with patients regarding the use of new technology. “It begins and ends with trust and confidence in your local team and your physician,” she concluded. “A better-informed, better-educated person is better able to manage their condition, but you can only achieve that when the medical experts explain it to you. So: communication, confidence, trust.”