Offering a simple health check alongside a Covid-19 jab is helping to reduce risks associated with cardiovascular disease (CVD) following disruption to prevention services caused by the pandemic. Targeted heart rhythm checks have been offered at some vaccination centres as a way of reaching vulnerable people at a time when other options for health checks have not been available.
The Oxford AHSN, in collaboration with the clinical leads for stroke at the Getting It Right First Time (GIRFT) programme, also developed guidance on delivering checks in vaccination centres, to share the learning across the country. This is the latest in a series of practical resources produced by the two organisations, along with other partners, to share best practice.
What’s the challenge and solution?
Risk factors for stroke are usually picked up at routine GP appointments, but the pandemic has meant far fewer of these face-to-face consultations have taken place. An irregular pulse is an indication of atrial fibrillation (AF), which is a major cause of stroke. An estimated 250,000 people in England have undetected AF and most are at a significantly increased risk of stroke. Once AF has been diagnosed, people can be counselled on their stroke risk and how to reduce it, and oral anticoagulation therapy started if appropriate. Strokes cause life-changing disability and death; reducing the risk of stroke improves quality of life and eases pressure on NHS and social care services. Hypertension, an increase in blood pressure (BP) present in a third of older people, is the other major cause of stroke. BP-lowering drugs substantially reduce the risk of stroke.
What did we do?
The early focus of the mass vaccination campaign was on over-65s – the age group most at risk of stroke and other forms of CVD. Targeted heart rhythm and BP checks were offered at some vaccination centres as a way of reaching some of these people at a time when other options for health checks had been disrupted. The offer was extended to other age groups and returned with the booster clinics later in the year.
One of the first locations to trial offering heart rhythm checks to over-65s in vaccination clinics was Slough. Dr Nithya Nanda, a GP in Slough and the East Berkshire CVD and diabetes clinical lead, said: “Lockdown restrictions meant we were seeing fewer people in primary care. Vaccinating our over-65 population presented a perfect opportunity to detect, protect and prevent stroke in high-risk patients with undetected atrial fibrillation. We have received good feedback from both patients and healthcare professionals. Making every contact count makes a difference.”
This approach has now been rolled out across the wider Frimley Health and Care integrated care system (ICS), with people being offered additional tests as part of a full NHS health check. ICS leaders in other parts of the Oxford AHSN region are developing similar plans.
Amanda Pritchard, the new Chief Executive of NHS England, highlighted the potential of this approach during her address at the 2021 NHS Confederation conference.
The Oxford AHSN, in collaboration with the clinical leads for stroke at the Getting It Right First Time (GIRFT) programme, also developed guidance on delivering checks in vaccination centres, to help systems that wish to follow suit. This is the latest in a series of practical resources produced by the two organisations, along with other partners, to share best practice around CVD prevention to counter disruption caused by the pandemic.
A research paper titled ‘Targeted atrial fibrillation detection in Covid-19 vaccination clinics’ was published in the European Heart Journal – Quality of Care in Clinical Outcomes, December 2021.
Initial pilot projects demonstrated the benefit of offering people aged over 65 attending vaccination centres an additional check to establish if they have atrial fibrillation (AF), an irregular heart rhythm that is a major cause of stroke. Modelling suggests that 37 new cases of AF will be detected and one stroke prevented for every 5,000 people offered a heart rhythm check at a vaccination clinic each year. If everyone aged 65 and over was offered an annual rhythm check more than 1,000 strokes could be prevented in England every year.
Hannah Oatley, Clinical Innovation Adoption Manager firstname.lastname@example.org