Supermarket trolleys help in heart rhythm diagnosis and stroke prevention

The shopping trip that saves life.


The use of supermarket trolleys to identify atrial fibrillation, which can be treated to prevent crippling or fatal strokes, is being investigated.

The new study indicates the potential of taking health screenings to the public without disrupting daily activities.

Over two months, 39 patients unaware of atrial fibrillation were detected, suggesting that 39 people at higher risk of stroke were referred to a cardiologist.

Atrial fibrillation, the most prevalent heart rhythm problem, affects more than 40 million people globally. Atrial fibrillation is the chance of stroke, and these strokes are frequently deadly or debilitating.

Anticoagulation significantly reduces the risk, although many patients are first diagnosed with atrial fibrillation after having a stroke. Screening programs are thus required to identify patients with the illness and provide them with preventive medication.

The SHOPS-AF study evaluated whether incorporating electrocardiogram (ECG) sensors into supermarket trolley handles could successfully detect shoppers with atrial fibrillation. 

During the two-month research, ten trolleys with sensors in the handles were used in four supermarkets with pharmacies in Liverpool.

Participants were instructed to operate a modified trolley while holding the handlebar for at least 60 seconds. If no abnormal heartbeats were detected, the sensor lighted up green. A researcher performed a manual pulse check on these participants to ensure no atrial fibrillation.

The sensor turned red if an abnormal heartbeat was detected. The in-store chemist then performed a manual pulse check and another sensor reading while the subject stood stationary, using an independent bar not attached to a cart.

The ECG recordings of participants with a red light and irregular pulse were reviewed by the study cardiologist, and the results were as follows:

1) No atrial fibrillation

2) Unclear ECG and an invitation to repeat the measurement

3) Atrial fibrillation confirmed, and a cardiologist appointment within two weeks

A total of 2,155 adults used a shopping cart. ECG data were available for 220 people who exhibited a red light on the sensor and an erratic pulse, indicating atrial fibrillation. Following an ECG evaluation by the research cardiologist, 115 participants had no evidence of atrial fibrillation, 46 recordings were inconclusive, and 59 people had atrial fibrillation identified.

The average age of the 59 individuals with atrial fibrillation was 74 years, with women accounting for 43%. Twenty already knew they had atrial fibrillation, while 39 were undiagnosed.

The researchers ran three analyses to test the accuracy of screening using this method:

1) Eliminating all 46 unclear ECGs. 2) Assuming all unclear ECGs were atrial fibrillation. 3) Assuming all confused ECGs were not atrial fibrillation.

The sensor’s sensitivity ranged from 0.70 to 0.93, specificity from 0.15 to 0.97, and positive predictive value from 0.24 to 0.56, indicating that only one-quarter to one-half of those diagnosed with atrial fibrillation using the sensor and manual pulse check had the condition.

The negative predictive value ranged between 0.55 and 1.00, indicating that this method would miss nearly half of all cases of atrial fibrillation.

Professor Jones said, “Nearly two-thirds of the shoppers we approached were happy to use a trolley, and most of those who declined were in a rush rather than wary of being monitored.”

He added, “ESC Guidelines require just a 30-second ECG to diagnose atrial fibrillation, so we aim to find a sensor that will halve the time shoppers need to hold the bar continuously.”

The new study shows that the concept is acceptable to most people and worth testing in a larger study. Before we conduct SHOPS-AF II, some adjustments are needed to make the system more accurate.

The research is presented today at ACNAP 2023, a scientific congress of the European Society of Cardiology (ESC).

The conclusion shows that checking for atrial fibrillation when people go shopping can prevent strokes and save lives. Immediate access to a health practitioner who can explain the findings and refer people for confirmation tests and medicines is critical.

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