People who suffer a stroke are being offered fast access to an implanted heart monitor in a bid to prevent a second attack.
A pilot scheme at the National Hospital for Neurology and Neurosurgery, in Bloomsbury, aims to reduce the average time to have a monitor fitted from 10 months to one by enabling it to be done by specialist stroke nurses.
This avoids the need to refer patients to cardiologists at the Barts Heart Centre, in Smithfield – one of many initiatives aiming to reduce the NHS’s pandemic backlog of 6.2m people awaiting non-emergency care.
The £2,000 device, which is similar to but smaller than a USB stick, is able to detect if the stroke was caused by atrial fibrillation, a heart condition that causes an irregular and often abnormally fast heart rate.
Detection allows the patient to be prescribed anticoagulant medication within 24 hours – dramatically cutting their risk of suffering a second stroke.
Patients who suffered a cryptogenic stroke - where the cause has not been identified – or a TIA (transient ischaemic attack), also known as a “mini stroke”, will be targeted.
Dr Arvind Chandratheva, UCLH consultant neurologist, said: “Once you have had a stroke or TIA, I think one of the biggest fears of patients is: what is my chance of having one again?
“Atrial fibrillation is an abnormal [heart] rhythm that puts some people at quite high risk of having another stroke.
“Treatment can reduce the risk of further stroke by about two-thirds. So it is critical to identify it – but it is really tricky to identify.”
The Reveal LINQ device, known as an ILR (implantable loop recorder), is implanted in the left side of the chest and sits under the skin.
Jasper Dade, 55, was one of the first to receive an implant at the National hospital, which is part of University College London Hospitals NHS Trust.
His 30-minute procedure, which is done under local anaesthetic, was carried out by stroke nurse practitioner Selina Edwards on January 31.
Mr Dade, who suffered three strokes over four years, said the device was far preferable to wearing an external heart monitor, which had made it difficult to wash and sleep.
The device links to a home hub, and any abnormal readings indicating the presence of atrial fibrillation triggers an alert to the hospital.
“It’s fantastic,” Mr Dade said. “It’s working 24 hours a day. It’s not getting in the way. You can continue to live your life as normally as possible. It’s quite reassuring to know it’s there and constantly monitoring me.”
Implantation of cardiac monitors, which can remain in place for three years, was previously the sole remit of cardiologists.
Ms Edwards and fellow nurse practitioner Roberto Macarimban Inglesant are believed to be the first stroke nurses in the UK to implant these devices. Five patients have had monitors fitted to date at the National hospital.
Ms Edwards said: “This results in a much quicker outcome for our patients, rather than having them waiting up to a year. Everything is done ‘in house’.”
Diabetes, high blood pressure and heart disease can increase the risk of atrial fibrillation.
Non-invasive heart monitors are routinely used on stroke patients for up to a week after an attack but often these fail to detect atrial fibrillation – creating the need for implanted devices.
“The atrial fibrillation strokes are those often associated with the highest morbidity and mortality,” Dr Chandratheva said. “It’s a clot from the heart that goes up, and it generally blocks a big important vessel.”