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AF Expression of Interest Form

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Expression of Interest in 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 you 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 10 minutes. You will need to provide the following baseline practice figures on AF diagnosis and management as of end of June 2017:

  • The total population of your practice
  • Number of patients diagnosed with AF and the number of patients with AF with a CHA2DS2-VASc score of 2 or more (at high risk of stroke)
  • Number of patients with AF with a CHA2DS2-VASc score of 2 or more who are currently treated with anti-coagulation drug therapy

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 Guy Wood, guy.wood@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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Please provide baseline practice figures on AF diagnosis and management as at end of June 2017

Total Practice Population – All ages(*)
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Number of patients diagnosed with AF(*)
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Number of patients with AF with a CHA2DS2-VASc score of 2 or more (at high risk of stroke)(*)
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Number of patients with AF with a CHA2DS2-VASc score of 2 or more who are currently treated with anti-coagulation drug therapy(*)
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Plans for use of AliveCor Kardia devices
The GP practice plans to target use of the AliveCor Kardia devices to detect AF in the following ways:

Opportunistic screening during routine consultations(*)
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During Flu Clinics to be held this year (2017-18) (*)
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During NHS health checks(*)
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Hypertension Annual Review Clinics(*)
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Obstructive Sleep Apnoea patients (*)
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Heart Failure patients(*)
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Annual Review of patients with long term conditions including Stroke, CVD, IHD, PAD, COPD, Diabetes(*)
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BMI >40(*)
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Loan of device to patients with palpitations to screen for AF(*)
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Other please state:
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Evidence summary: 1) Age is the biggest non-modifiable risk factor for AF (AF prevalence roughly doubles with each successive decade of life after 65); 2) Hypertension is the commonest modifiable risk factor for AF in a western population, 3) Obstructive sleep apnoea patients have a 7 fold lifetime increase risk of AF

AF Toolkit

We have developed resources to support practices in implementing the AliveCor Kardia device including protocol, GP surgery poster and patient information. You can access these resources by visiting http://emahsn.org.uk/atrial-fibrillation/af-toolkit/
 

Practice Agreement to implement AliveCor Kardia device and provide information on outcomes


The practice agrees to implement the AliveCor Kardia device as outlined
The practice agrees to support evaluation of the outcomes of using the AliveCor Kardia devices by providing the following information to East Midlands Academic Health Science Network: (practices can easily get this information by running GraspAF report)
  • Number of AF patients: 1) diagnosed with atrial fibrillation; 2) AF patients at high risk of a stroke; 3)AF patients at high risk of stroke on anticoagulation treatment
  • Quarterly information as follows: baseline data as at end of June 2017 followed by quarterly at end of September 2017, December 2017, March 2018 and June 2018

The practice agrees to return the Kardia mobile ECG devices to EMAHSN if they are not being adequately used
Signature(*)
Please confirm that the details provided above are correct

Name(*)
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Title(*)
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