“The NHS Long Term Plan1 was published in January 2019 and set the plan for the NHS for the next 10 years. Cardiovascular disease was identified as a national clinical priority
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated overall population prevalence in England of 2.5%. It is estimated that in 2016, around 1.4 million people in England were living with AF. Of these 425,000 were estimated to be undiagnosed and untreated.
A community-based Ambulatory ECG service facilitates early detection and the accurate
diagnosis of conditions such as AF, enabling clinicians to provide patients with a
diagnosis and treatment in a timely manner. It reduces the risk of harm to those patients
who may otherwise experience long waiting times to access the service via secondary
care and whose diagnosis and treatment may be delayed as a result of this. The prompt
management of such conditions benefits the health system as a whole. Patients
presenting with palpitations are often very anxious about their symptoms. They have
been advised, in the past, to attend ED when they have symptoms, as capturing their
symptomatic episodes can result in diagnosis. With a prompt community-based service
offering up to 7 day recordings, depending upon frequency of symptoms, the diagnostic
yield of the test is optimized. The service contributes to a reduction in ED attendances
when patients are awaiting a diagnosis and in the number of referrals to secondary care
for diagnostic testing
Ambulatory ECG recordings carried out within the service, which allows them to interrogate reports that Primary Care physicians have concerns about, or are reported as ‘Amber’. The utilisation of Advice and Guidance responses to reports can also act as a filter to ensure those that need outpatient care can receive it in the most efficient manner.
The service reduces demand on secondary care at a time when waiting times are high in secondary care and demonstrates value for money when comparing to national tariffs. On this basis the intention is to issue a new contract for 2024/25.”