Healthcare delivery
Establishing a pioneering stroke arrhythmia pathway
In this article, a team from the University College London Hospital provide an insight into a pioneering stroke arrhythmia pathway. They discuss the importance of early intervention and long-term cardiac monitoring technologies to improve patient outcomes post-stroke.
Stroke is one of the leading causes of death and disability in the UK.1
have a stroke across Europe2
Each year, 1.5 million people ; 25% of these are
classified as cryptogenic, with no clear aetiology or cause.3
25% to 30% of cryptogenic strokes
are the result of atrial fibrillation (AF) – a type of irregular heartbeat that can cause blood clots to form in a patient’s heart, increasing their risk of stroke.4
AF has very few symptoms and
is challenging to diagnose. One in four stroke survivors will experience another (secondary) stroke within five years,5
which can be more
severe and disabling than the first.6 For many stroke survivors, there is a lot of emphasis on “returning to normal”. Healthcare decision-makers are increasingly prioritising care beyond the hospital to support this process. Clinical monitoring technologies can provide timely insights into a patient’s status across care settings, generating actionable results that help caregivers move from reacting to adverse events that have already occurred, to proactively addressing impending, potentially life-threatening events. Crucially, this allows patients to keep an active lifestyle, while having the peace of mind that care teams can monitor their health remotely. Insertable cardiac monitors (ICMs) are diagnostic devices that operate 24 hours a day for a duration of three to four years, recording heart rate and rhythm. They work continuously to monitor stroke and TIA patients, providing comfort that there will be further investigation into the factors
contributing to their stroke as needed. In recognition of the value of stroke patient support in the community, together, Dr. Chandratheva, Dr. Simister and nurses Edwards and Macarimban, developed a new stroke arrhythmia pathway and referral process. This restructuring process took stroke and TIA patients from St Barts Health NHS Trust, a local cardiac tertiary centre, to the UK’s first specialised nurse-led stroke service.
Identifying an opportunity to streamline the stroke patient pathway During an individual’s stroke journey, their community is the most variable factor, which can cause distinctive health disparities among
Remote patient monitoring allows healthcare teams to monitor patients outside the hospital, reprogramme devices, and capture medical data from patients without needing to arrange an in-clinic visit. This data can be transmitted electronically to consultants for clinical assessment.
survivors. Geographical location can impact access to appropriate care, and often the severity of patient functioning post-stroke varies significantly i.e., some suffer with cognitive abnormalities, anxiety, or disability, while others have very few symptoms. Once in the community, typically patients receive a follow-up appointment with a doctor and may receive an additional follow-up with their community therapy team. This provides limited medical interaction with the patient. Multidisciplinary clinical support can be
extremely valuable, although it can present a resourcing challenge across the already stretched NHS. There is an increasing need for stroke patient support for the duration of an individual’s recovery journey, which in some instances can be lengthy and, therefore, costly. Dr. Chandratheva, Dr. Simister, and nurses
Edwards and Macarimban identified an opportunity to streamline processes by utilising ICMs to identify AF in patients in the comfort of their own homes. Prior to the revised pathway, patients were referred to a local cardiac tertiary centre, St Barts Health NHS Trust. The UCLH team piloted their new pathway comprising of a minimally invasive procedure that required just a single stroke nurse practitioner to insert the Reveal LINQ cardiac monitoring device,
September 2023 I
www.clinicalservicesjournal.com 57
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76
