EMAHSN

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Expression of Interest and MOU for the use of AliveCor Kardia device to detect Atrial Fibrillation

East Midlands Academic Health Science Network, East Midlands Clinical Network and other partner organisations have joined forces to implement the atrial fibrillation Advance Programme to work with CCGs and GP practices in East Midlands to improve the diagnosis and management of atrial fibrillation. As part of this programme, if your GP practice is interested, we will provide you with the AliveCor Kardia device which will support you in detecting patients with atrial fibrillation.

Completing this form should take around 15 minutes. If your practice would like to participate please complete this expression of interest form before the deadline agreed with your CCG. For any queries please contact Karen Glover, karen.glover@nottingham.ac.uk or on 07450634232

GP Practice Details

Clinical Commissioning Group(*)

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GP Practice name(*)

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GP Practice main surgery address for delivery of devices

Address Line 1(*)

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Address Line 2

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City(*)

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Postcode(*)

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Practice manager name(*)

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Practice manager email address(*)

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Direct dial telephone number(*)

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Does your practice have GraspAF installed?(*)

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Clinical lead and upskilling in AF

What is the name and email address for your GP Clinical lead who will oversee the implementation of the AliveCor Kardia device within your GP practice?

Name(*)

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Email(*)

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When did your clinical lead last attend an upskilling workshop or course on atrial fibrillation?

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Number of AliveCor Kardia devices – current and further requirements

Does your GP practice have any AliveCor Kardia devices already?(*)

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If yes, how many?

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How many branch surgeries do you have?(*)

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How many AliveCor Kardia devices does your GP practice require? Note: We are aiming to provide a maximum of 3 devices for each GP practice plus one for each branch surgery(*)

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Practice commitment to use of the AliveCor Kardia devices to improve diagnosis of AF

I would like to participate in the use of the AliveCor Kardia devices to improve the detection of atrial fibrillation(*)

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The GP practice aims to increase the prevalence of patients diagnosed with atrial fibrillation by 10%(*)

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Availability within the GP practice of phones or tablets to support use the AliveCor Kardia device

To use the AliveCor Kardia device it has to be attached or linked to an android phone or tablet or iPhone or iPad tablet. A list of compatible Apple & Android phones and tablets is available via this link https://store.alivecor.com/#compatibility

How does your practice intend to use the devices?

Clinicians plan to use their personal phones or tablets(*)

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Clinicians will be able to use practice phones or tablets(*)

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Alivecor Kardia app user/clinician email address registration

Data on usage of the Kardia mobile ECG and app is being undertaken centrally. All potential users of Kardia mobile app must please provide all the email addresses that will be used to register/log in to the Kardia app. This will enable the AHSN to monitor usage of the AliveCor Kardia device including outcomes of AF screen e.g. normal/abnormal trace.

Email address 1