by Ruggiero Corcella
A UK study tested trolleys with EKG sensors in the handles and identified 39 people who didn’t know they had the condition
Does shopping save your life? Try to explain it to those who develop a real obsession – compulsive shopping – with all due respect to the wallet and mental balance. However, in the study presented at ACNAP (Association of Cardiovascular Nursing & Allied Professions) 2023a scientific congress of the European Society of Cardiology (ESC)shopping could really become a lifesaver.
The – ingenious – idea of researchers at Liverpool John Moores University, in the United Kingdom, led by Professor Ian Jones exploits all the potential of digital healthcare: “smart” supermarket trolleys, equipped with an electrocardiogram sensor positioned on the handle, to diagnose atrial fibrillation which can then be treated to prevent disabling or fatal strokes. In short, an additional tool alongside smartwatches and wristbands that monitor any arrhythmias (abnormal variations in heart rhythm), which can be of benign origin, such as extrasystoles; or atrial fibrillation and supraventricular or ventricular tachycardias, which can be life threatening to the person.
“Mass” health checks
“This study demonstrates how it is possible to extend health checks to the population without interrupting the daily routine,” says Professor Jones (who is a professor of Nursing and Heart Care). “Over the course of two months, we identified 39 patients who were unaware they had atrial fibrillation. There are 39 people at increased risk of stroke who have received an appointment with the cardiologist.
What is atrial fibrillation
More than 40 million people worldwide suffer from atrial fibrillation, the most common heart rhythm disorder. Atrial fibrillation increases the risk of strokes fivefold, which are often fatal or leave disabling sequelae. Anticoagulant therapy substantially reduces the risk, but many people only find out they have atrial fibrillation after having a stroke. Screening programs are therefore needed to identify people with this disease so that they can receive preventive drugs.
I study
Lo studio SHOPS-AF
examined whether integrating electrocardiogram (ECG) sensors into supermarket trolley handles could effectively identify shoppers with atrial fibrillation. Ten trolleys had a sensor placed in the handle and were used in four supermarkets and pharmacies in Liverpool during the two month study. Clients were asked to use a modified handcart and hold the handlebars for at least 60 seconds. If the sensor didn’t detect an irregular heartbeat, it would light up green.
These participants underwent a manual pulse check by a researcher to confirm the absence of atrial fibrillation. If an irregular heartbeat was detected, the sensor would glow red. The in-store pharmacist then performed a manual pulse check and another sensor reading using a self-contained bar not attached to a cart with the participant stationary. The study cardiologist examined the ECG tracings of participants with red light and/or irregular pulse. Participants were informed of the results, which were: 1) absence of atrial fibrillation; 2) ECG unclear and request to repeat the measurement; or 3) confirmed atrial fibrillation and appointment with a cardiologist within two weeks.
Involved over two thousand people
A total of 2,155 adults used a shopping cart. ECG data was available for 220 participants who had a red light on the sensor and/or an irregular pulse, suggesting atrial fibrillation. Upon review of the ECG by the study cardiologist, there was no evidence of atrial fibrillation in 115 participants, 46 recordings were unclear, and atrial fibrillation was diagnosed in 59 participants. The mean age of the 59 participants with atrial fibrillation was 74, and 43% were female. Of these, 20 already knew they had atrial fibrillation and 39 had not been previously diagnosed.
To evaluate the accuracy of screening using this method, the researchers conducted three analyses: 1) excluding all 46 unclear ECGs; 2) assuming that all unclear ECGs were atrial fibrillation; and 3) assuming that all unclear ECGs were not atrial fibrillation. This showed that the sensitivity (i.e. the ability of the test to identify affected subjects) of the sensor ranged from 0.70 to 0.93 and the specificity (i.e. the ability of the test to identify subjects unaffected by a given disease) varied from 0.15 to 0.97. This resulted in a positive predictive value of between 0.24 and 0.56, meaning that only a quarter to a half of those diagnosed with atrial fibrillation based on the sensor and/or manual pulse check actually had the pathology (i.e. there was a high number of false positives).
The negative predictive value ranged from 0.55 to 1.00, meaning that approximately half of actual atrial fibrillation cases would have been missed using this method (i.e., false negatives).
People’s reaction and future developments
How did the customers of the supermarkets where the study was carried out react? “Nearly two-thirds of the shoppers we contacted were happy to use a trolley, and the vast majority of those who declined were in a hurry rather than wary of being tracked,” responds Professor Jones. “This shows that the concept is acceptable to most people and worth testing in a larger study. Before conducting SHOPS-AF II, some modifications are needed to make the system more accurate. For example, having a precise position on the handle, as the movement of the hand interfered with the readings».
“Furthermore,
the ESC guidelines they only require a 30-second ECG to diagnose atrial fibrillation, so we aim to find a sensor that cuts in half the time it takes for buyers to continuously hold the sensor portion of the handle.” He concluded: “Controlling atrial fibrillation while people do their regular shopping holds promise of preventing strokes and saving lives. Crucially, we provide immediate access to a healthcare professional who can explain the findings and refer patients for confirmatory tests and medications if needed,” concludes Jones.
June 24, 2023 (change June 24, 2023 | 3:15 pm)
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