Smartphone stroke test in pharmacies

The test is reportedly quick and accurate, and can cheaply diagnose unknown atrial fibrillation (AF), a common abnormal heart rhythm that causes a third of all strokes and doubles the chances of premature death.

If the test is rolled out to the Australian population aged between 65 and 84, the researchers predict that could prevent 1,228 strokes over a decade, or 122 strokes each year.

Atrial fibrillation often goes undetected and may have no symptoms before causing a stroke, which is sometimes fatal. It is especially common in people aged over 65 years, and is largely preventable by blood thinning medication.

The University of Sydney study, published in the journal Thrombosis and Haemostasis today, screened 1,000 people in pharmacies aged 65 years and over and found unrecognised AF in 1.5% of participants.

Paper lead author, Nicole Lowres, says most participants were asymptomatic and all were at a significantly increased risk of stroke.

“Unfortunately, many who have AF are unaware and have no symptoms that would lead them to visit their doctor,” she says.

“We predicted this finding from our previous systematic review of all screening studies, which found a total incidence of unknown AF of 1.4% in those over 65 years.

“We also found AF screening picked up many people (about 5% of all those screened) with known AF (known to their treating doctor).

“Unfortunately, almost half of these did not know they had AF, even though most of them were taking powerful blood thinners. This indicates a great knowledge gap in people with this rhythm problem.”

Ms Lowres hopes the study will heighten community awareness of the risk to health that unknown AF poses, because the researchers also highlighted a great lack of knowledge of this condition, even amongst people in whom AF is known.

The researchers also did a formal cost effectiveness analysis, and found the cost/benefit ratios of prevention of stroke and increases in Quality Adjusted Life Years (QALY) by screening were well within the range that health providers would find fundable.

Paper senior author, Professor Ben Freedman, says the findings have great significance for whether a screening program for unknown AF could be introduced, and how and where the screening should be done.

“If the screening was extended to the general community, the incremental cost-effectiveness ratio would be $5,988 per Quality Adjusted Life Year (QALY) gained and $30,481 for prevention of one stroke.

“The method of adjusting life years gained by quality of life, takes into account that people who have had the type of stroke AF produces, would be prepared to trade about five years of their life to have avoided the stroke.”

According to Professor Freedman, for health providers, this simple screening test is likely to be cost effective for the prevention of disability and death due to stroke if screening is carried out in otherwise well people aged 65 years and over.

“The findings could change clinical practice guidelines on screening for AF, and could form part of health policy for governments or health service providers wishing to reduce the community burden of stroke.

“There will also be an increased recognition of the role health providers like pharmacists could play in screening for serious conditions using novel technology like the iPhone ECG,” he says.

Screening in pharmacies and also in primary care by physicians and nurses to detect unknown AF in those over 65 might become part of routine practice, and could prevent death and disability from stroke, he claims.

“When screening becomes more generally available, those over 65 will want to include this as part of their regular health checks.”