About the study
Global National Institute for Health Research(NIHR) AF is an international research, ongoing in the University of Jaffna, Sri Lanka, in collaboration with the University of Birmingham, Brazil and China.
AF is commonest sustained cardiac rhythm disorder globally, conferring a major burden of morbidity and mortality from stroke, heart failure, and dementia. However, there is a lack of baseline data and awareness of AF in developing countries such as Sri Lanka.
To the comprehensive and effective management, a simple 3-step approach (the ‘ABC pathway’) is proposed to streamline primary and secondary care AF management, i.e. Avoid stroke (Anticoagulation), Better symptom management (with rate or rhythm control), and Cardiovascular/ comorbidity risk management.
We have identified four key areas that need to be tackled to improve health systems to manage AF.
- A targeted screening program
- Better diagnosis and risk stratification
- Early referral to hospital clinics
- Improved data sharing and communication between the community and hospital care
AF project management at the University of Jaffna
Themes and Aims
In order to achieve the project goal, three themes have been proposed.
Lead: Dr.S.Kumaran MBBS, DFM, MD
A community-based survey among 10,000 above 50 years old in Northern Province, Sri Lanka was proposed. The community-survey is implemented through a mobile data collection process called “REDCap” to get the general health data, related health care cost and risk status for AF. A mobile-based single lead ECG called “Alivecor – Kardia“ is taken from all participants laboratory investigations for basic and novel biomarkers to evaluate the risk and prognosis will be done. Bio samples will be stored using cryo banking and from these baseline data sub cohorts and nested case control studies will take place.
Lead: Dr B.Kumarendran MBBS, M.Sc, MD, FRSPH
Evaluation of existing AF management pathway is done with the possible key stakeholders through pathway mapping, focus group discussions and interviews via qualitative and quantitative studies. From the AF pathway mapping data, a comprehensive mHealth platform will be implemented at the health care settings in an iterative process manner through consecutive adoptive evaluations to manage AF. The existing acute care platform fuses mobile data entry with visual analytics from acute care facilities nationwide to provide patient and health services information up to 90 days following discharge. Built for smart-phones using Android technology, the platform has been co-designed and co-evaluated in partnership with multidisciplinary clinical and administrative teams, highlighting the platform’s adaptive interconnectivity. Alongside in-application visualization, real-time information regarding patient acuity, activity and measures of care quality are displayed in dashboards, facilitating stakeholder driven care evaluation and resource prioritization. The research team will partner with Guo and team on expertise from the pilot mAFa (mobile Atrial Fibrillation application) trial and the ongoing mAFa II outcome trial testing the ABC pathway in China (Lip Co-PI), to modify the platform’s functionality to include decision support tools for AF, chronic disease specific data capture and multi-user synchronized communication. The collaboration will harness existing expertise in application design, data structuring and mobile communication. Once the patient’s clinical and demographic information has been captured, risk prediction tools (CHADS2 VASc & HAS – BLED2) will automatically calculate risk scores, alerting clinicians to priorities in referral and providing decision support, as operationalized in the mAFa pilot trial, in early recognition and management of AF.