Nearly 2,000 people have taken part in a groundbreaking trial that aims to help doctors identify more people at risk of developing a condition that makes them five times more likely to have a stroke.
Atrial fibrillation (AF) is a common abnormal heart rhythm where the electrical impulses that trigger the heartbeat fire chaotically instead of in a regular and steady way. The condition dramatically increases a patient's risk of having a a potentially fatal or life-changing stroke but, with early diagnosis and treatment, it can be managed effectively and stroke risk reduced.
The trial is investigating an algorithm called FIND-AF – developed using machine learning - that searches people's GP records to identify red flags suggesting they're at risk of developing AF in the next six months. These patients are then offered further testing to confirm a diagnosis of AF.
All too often, the first sign that someone is living with undiagnosed atrial fibrillation is a stroke. This can be devastating for patients and their families, changing their lives in an instant.
The team hope the West Yorkshire pilot study will lay the groundwork for a UK-wide trial that could one day improve early diagnosis of AF and prevent more avoidable strokes. The study is being made possible thanks to funding from the British Heart Foundation and Leeds Hospitals Charity.
The trial is led by Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds and Honorary Consultant Cardiologist at Leeds Teaching Hospitals NHS Trust. He said:
"All too often, the first sign that someone is living with undiagnosed atrial fibrillation is a stroke. This can be devastating for patients and their families, changing their lives in an instant. It also has major cost implications for health and social care services – costs which could have been avoided if the condition were spotted and treated earlier.
"Our FIND-AF digital diagnostic and treatment care pathway supports Government's ambition of moving from treating illness to preventing it. We're now looking to partner with the NHS and other providers to accelerate its use more widely."
More than 1.6 million people in the UK have been diagnosed with AF. But there are likely to be many thousands more people in the UK who remain undiagnosed and unaware they're living with the condition. It's estimated that AF is a contributing factor in around 20,000 strokes each year in the UK.
In the current study, the algorithm has been implemented at several GP surgeries in West Yorkshire. People identified as at risk of AF are offered at-home testing. Those who agree are sent a handheld ECG machine – a device that can measure their heart rhythm – and asked to take two readings a day for four weeks, as well as any time they feel palpitations. This can all be done with no need for people to visit their GP surgery.
If the ECG readings reveal that they have AF, their GP is informed, and they can then discuss treatment options.
[T]his research offers a real opportunity to identify more people who are at risk of atrial fibrillation, and who may benefit from treatment to reduce their risk of a devastating stroke.
The FIND-AF algorithm was developed by scientists and clinicians at the University of Leeds and Leeds Teaching Hospitals NHS Trust, with funding from the BHF. Using the anonymised electronic health records of over 2.1 million people, the team trained the algorithm to find warning signs that suggest that they're at high risk of developing AF in the next six months. The algorithm was then validated using data from over 10 million people in countries outside the UK.
Dr Ramesh Nadarajah, Academic Clinical Lecturer in Cardiology at Leeds Teaching Hospitals NHS Trust, said: "Data are collected about patients in every interaction they have with the NHS. These data have huge potential to make early identification of and testing for conditions like AF easier and more efficient.
"If it's successful, this study will be the launchpad for a larger nationwide trial to determine whether our algorithm could become part of everyday clinical practice. Ultimately, we hope that this approach will lead to an increase in the number of people diagnosed with AF at an early stage who get the treatment they need to reduce their risk of stroke."
Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation and consultant cardiologist, said: "We have effective treatments for people with atrial fibrillation who are at high risk of having a stroke. But right now, some people are missing out because they don't know that they may be living with this hidden threat to their health.
"By harnessing the power of routinely collected health care data and prediction algorithms, this research offers a real opportunity to identify more people who are at risk of atrial fibrillation, and who may benefit from treatment to reduce their risk of a devastating stroke."
Rebecca Baldaro-Booth, Head of Grants at Leeds Hospitals Charity, said: "We are delighted to support the expansion of this worthwhile project into the local community. Thanks to donations and gifts in Wills, we have been able to invest over £43,000, giving more than 450 people across our region the opportunity to be part of this important study. This will enable people who are at risk of developing atrial fibrillation to have access to treatment that can significantly improve their health outcomes and quality of life."
The trial in West Yorkshire is funded by BHF with a philanthropic donation from Bristol Myers Squibb. Daiichi Sankyo are also supporting the roll-out of the algorithm through a partnership with Leeds Teaching Hospitals NHS Trust.
John's story
John Pengelly, 74, from Apperley Bridge spent 29 years in the Army Catering Corps, where he reached the rank of Captain.
John and his wife Paula moved to Yorkshire four years ago to be closer to their daughter. The retired grandfather was diagnosed with AF in summer 2024 after taking part in the FIND-AF at-home screening.
"I got a letter inviting me to take part in the study and I thought if it benefits somebody then great, I want to help. They sent me a little digital monitor and a few times a day I had to put my thumbs on it so it could take a reading, which took about two minutes. Then I pressed send and the reading went to the trial team. I did that for a few weeks, and I sent the kit back – it was really straightforward.
"I was diagnosed with AF a few weeks after that. I'd heard of it, but you never think that these things will happen to you. So, when the doctor told me I just thought, 'oh gosh, what does this mean for me?'
"I didn't have any symptoms. I'd occasionally get a bit breathless when I'm out and about, but that's because there's so many hills around us and some of them are really steep. I also had an ECG a few years ago, before we moved up to Yorkshire, and nothing showed up on that.
"I'm really grateful it has been picked up. I now take a couple of pills every day to reduce my risk of having a stroke. In the Army, if the doctor tells you to do something, you do it – that never really leaves you.
"It hasn't been a problem for me, and it hasn't had a big impact on my life. I just think, 'great, they're trying to keep me alive.' It's just a few pills every day that will hopefully keep me going for a good few more years yet."
