CReD 

Real-time ambulance to GP notification of atrial fibrillation and atrial flutter: A digital solution to prevent stroke

Atrial fibrillation and atrial flutter (AF) are associated with an increased risk of stroke and systemic embolism. This risk can be substantially reduced using oral anticoagulant (OAC) medications, but as AF can be asymptomatic, it often goes unnoticed. Ambulance clinicians can therefore sometimes detect AF as an incidental finding during their routine assessment of patients. In the instance of the patient then not being taken to hospital, this information needs to be passed on to the general practitioner (GP) for review and follow up. Currently, individual clinicians contact GPs directly to let them know when AF is identified, which is not always possible and can take time. In partnership with ambulance clinicians and GPs, we have developed a new tool within the existing ambulance electronic patient care record so that a letter can automatically be sent to the GP, with the ECG attached, for patients in whom incidental AF is detected. In the year after this notification process launches we will measure how often it is used, whether the GP record has been updated with the AF diagnosis and if appropriate medication was then prescribed. Data from comparator patients in the year before the intervention was live will also be analysed, as well as those eligible but not exposed to the new notification process.

The primary outcome is entry onto the general practice atrial fibrillation register within six weeks of ambulance contact. Secondary outcomes will be to: 1. Compare rates of AF identified on the electronic patient care record by NEAS clinicians between year one and year two. 2. Report the proportion of potentially eligible patients with AF in year 2 in whom the novel notification system was used 3. Report the ‘time on scene’ for NEAS clinicians for non-conveyed patients with AF in year 2, stratified by whether the notification system was used or not 4. Using linked primary care records, identify rates of new prescription of OAC in the six weeks following ambulance attendance for all patients with AF seen by a NEAS clinician in years one and two. Compare rates between years one and two (stratified by whether the notification system was used or not in year two). 5. Report the accuracy of AF identification by NEAS clinicians.

Quantitative Observation

2025-09-15

2026-12-31

British Heart Foundation Innovation Grant

United Kingdom

laura.blair@neas.nhs.uk

Dr Chris Wilkinson;