A groundbreaking research study called SHOPS-AF has introduced supermarket carts equipped with electrocardiogram (ECG) sensors. These innovative carts aim to identify atrial fibrillation in shoppers, potentially preventing devastating strokes.
The SHOPS-AF study employed supermarket carts fitted with ECG sensors as part of a pioneering public health initiative. While the method demonstrated a notable number of both false positives and negatives, it successfully detected 39 previously undiagnosed cases, leading to refinements for larger-scale trials.
Imagine a shopping trip that could potentially save your life. Supermarket carts now have the ability to diagnose atrial fibrillation, a condition that, when left untreated, can result in debilitating or fatal strokes. This research was recently presented on June 23 at ACNAP 2023, a scientific congress organized by the European Society of Cardiology (ESC) [1].
“This study demonstrates the potential of conducting health checks without disrupting people’s daily routines,” explained Professor Ian Jones from Liverpool John Moores University, UK, who is one of the study authors. “Over a span of two months, we identified 39 patients who were unaware of their atrial fibrillation. These individuals were at a higher risk of stroke, but thanks to this initiative, they were able to receive timely cardiologist appointments.”
Atrial fibrillation, the most prevalent heart rhythm disorder, affects over 40 million people worldwide [2]. It increases the risk of stroke by five-fold, often resulting in fatal or debilitating outcomes. While anticoagulation can significantly reduce this risk, many individuals only discover their atrial fibrillation after experiencing a stroke [3]. Therefore, screening programs are essential to identify those with the condition and provide them with preventive medication.
The SHOPS-AF study investigated the effectiveness of incorporating ECG sensors into supermarket cart handles to identify shoppers with atrial fibrillation (see photo) [4,5]. During the two-month study, ten carts were equipped with sensors and utilized across four supermarkets with pharmacies in Liverpool.
Shoppers were asked to use a modified cart and hold onto the handlebar for at least 60 seconds. If the sensor did not detect an irregular heartbeat, it illuminated in green. In such cases, participants underwent a manual pulse check by a researcher to confirm the absence of atrial fibrillation. However, if an irregular heartbeat was detected, the sensor lit up in red. At that point, the in-store pharmacist conducted a manual pulse check and another sensor reading using a standalone bar not attached to a cart, with the participant standing still. The study’s cardiologist reviewed the ECG recordings of participants exhibiting a red light and/or an irregular pulse. The participants were then informed of the results, which fell into one of three categories: 1) no atrial fibrillation; 2) an unclear ECG, with an invitation to repeat the measurement; or 3) confirmed atrial fibrillation, leading to a scheduled cardiologist appointment within two weeks.
During the study, a total of 2,155 adults used the shopping carts. ECG data were available for 220 participants who displayed either a red light on the sensor or an irregular pulse, indicating potential atrial fibrillation. After the study cardiologist reviewed the ECG recordings, it was found that 115 participants did not exhibit any evidence of atrial fibrillation, 46 recordings were inconclusive, and atrial fibrillation was diagnosed in 59 participants. The average age of the 59 individuals diagnosed with atrial fibrillation was 74 years, and 43% of them were women. Among the diagnosed participants, 20 were already aware of their condition, while 39 were previously undiagnosed.
To evaluate the screening method’s accuracy, the researchers conducted three analyses: 1) excluding all 46 inconclusive ECGs; 2) assuming all inconclusive ECGs indicated atrial fibrillation; and 3) assuming none of the inconclusive ECGs represented atrial fibrillation. These analyses revealed a sensor sensitivity range of 0.70 to 0.93 and a specificity range of 0.15 to 0.97. Consequently, the positive predictive value ranged from 0.24 to 0.56, indicating that only a quarter to half of the individuals identified as having atrial fibrillation by the sensor and/or manual pulse check actually had the condition (i.e., there were a significant number of false positives). The negative predictive value ranged from 0.55 to 1.00, suggesting that approximately half of the actual atrial fibrillation cases would be missed using this method (i.e., false negatives).
Professor Jones noted, “Nearly two-thirds of the shoppers we approached were willing to use the cart, and the majority of those who declined were in a hurry rather than wary of being monitored. This demonstrates that most people find the concept acceptable and warrants further testing in a larger study. Before conducting SHOPS-AF II, we need to make some adjustments to enhance the system’s accuracy. For instance, we plan to designate a specific position on the bar to hold onto, as hand movement interfered with the readings. Moreover, according to ESC Guidelines, only a 30-second ECG is required to diagnose atrial fibrillation [2], so our aim is to find a sensor that can reduce the time shoppers need to continuously hold the bar by half.”
He concluded, “Screening for atrial fibrillation during regular shopping holds great promise for preventing strokes and saving lives. Immediate access to healthcare professionals who can explain the findings and refer patients for confirmatory tests and appropriate medication is a critical aspect of this initiative.”
References:
- The abstract ‘SHOPS-AF’ will be presented during the session ‘Care of the patient beyond the hospital’ at the ACNAP Scientific Corner on June 23 at 15:30 CEST.
- “2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC” by Gerhard Hindricks et al., European Heart Journal, August 29, 2020. DOI: 10.1093/eurheartj/ehaa612
- “Stroke in atrial fibrillation: Review of risk stratification and preventive therapy” by Abdullah M. Alshehri, Journal of Family and Community Medicine, May-August 2019. DOI: 10.4103/jfcm.JFCM_99_18
- “Supermarket/hypermarket opportunistic screening for atrial fibrillation (SHOPS-AF): a mixed methods feasibility study protocol” by Ian D. Jones et al., Journal of Personalized Medicine, April 4, 2022. DOI: 10.3390/jpm12040578
- The study used a MyDiagnostick single-lead ECG sensor.
Table of Contents
Frequently Asked Questions (FAQs) about atrial fibrillation detection
What is the purpose of the SHOPS-AF study?
The purpose of the SHOPS-AF study was to investigate the effectiveness of using supermarket carts embedded with ECG sensors to detect atrial fibrillation in shoppers and potentially prevent strokes.
How common is atrial fibrillation?
Atrial fibrillation is the most common heart rhythm disorder, affecting over 40 million people worldwide.
How does atrial fibrillation increase the risk of stroke?
Atrial fibrillation increases the risk of stroke by five-fold. If left untreated, these strokes can be fatal or result in long-term disability.
How did the ECG sensors in the supermarket carts work?
Shoppers using the modified carts held onto the handlebar for at least 60 seconds. The ECG sensors detected irregular heartbeats. A green light indicated a normal heartbeat, while a red light signaled an irregular heartbeat, prompting further examination.
How accurate were the ECG sensors in detecting atrial fibrillation?
The ECG sensors showed a range of accuracy. The sensitivity ranged from 0.70 to 0.93, and the specificity ranged from 0.15 to 0.97. However, there were a significant number of false positives and false negatives, affecting the positive and negative predictive values.
How many previously undiagnosed cases of atrial fibrillation were identified?
The study identified 39 previously undiagnosed cases of atrial fibrillation among the shoppers.
What adjustments are needed for future studies?
To improve accuracy, adjustments such as a designated hand position on the cart’s bar and finding a sensor that reduces the required holding time are planned for future studies.
What is the potential impact of detecting atrial fibrillation during shopping trips?
Detecting atrial fibrillation during regular shopping trips holds promise for preventing strokes and saving lives. It allows immediate access to healthcare professionals for necessary follow-up tests and medication.
How can atrial fibrillation be treated or managed?
Atrial fibrillation can be managed through various approaches, including medication, lifestyle changes, and, in some cases, procedures such as cardioversion or ablation. Treatment aims to reduce the risk of strokes and control heart rhythm.
More about atrial fibrillation detection
- SHOPS-AF Study
- ESC Guidelines for Atrial Fibrillation
- Journal of Family and Community Medicine: Stroke in Atrial Fibrillation
- Journal of Personalized Medicine: SHOPS-AF Feasibility Study Protocol
