CVD healthy heart check pathway using PocDoc® rapid lipid testing
PocDoc® is an innovative point of care device which gives a 5 marker lipid panel result within eight minutes via a smart phone or tablet app. This innovation can detect people with markers pointing to cardiovascular disease (CVD) such as heart attacks and strokes quicker and in a non-clinical setting.
This project can identify people who haven’t attended their annual healthy heart check in the most deprived communities and aims to overcome barriers to accessing cholesterol testing by offering tests at home and in community locations; 10,000 tests are available across the region in a pilot phase. This dramatically increases access to testing which in turn aims to prevent more people from developing CVD.
We have been overwhelmed by the passion and determination of the HI NENC team in supporting the development of a new, community-centred, digitally enabled model of care for Cardiovascular Disease prevention with PocDoc as one of the leading examples. The clinical, technical and financial impacts as a result have been hugely positive and we believe it provides a perfect case study for the value-add of a Health Innovation. The project itself proved that by deploying digital solutions to conduct CVD screening in communities, upskilling community workers to deliver the screenings creates access to groups that are not receptive to other forms of engagement, finds huge volumes of people who are “untested, untreated” with extremely significant risk of developing CVD and can get them into treatment – doing in minutes which otherwise could take weeks, or never, using a traditional bricks and mortar primary care approach.
Each year over 6,700 people die from CVD across the North East and North Cumbria – the equivalent of 1 in 4 of all deaths. 2,000 of these people die under the age of 75 years[i].
There are an estimated 430,000 people living with cardiovascular disease in the region[ii], however there are likely to be many more who are undiagnosed.
Testing with PocDoc® is a five-step process which involves: downloading the PocDoc® app and filling out a health questionnaire; taking a finger prick sample of blood which is then added to the lateral flow device; allowing the test to develop for seven minutes; taking a photo of the results using a phone or tablet via the app; and then receiving results immediately which will determine whether a person has high cholesterol, alongside a personalised health assessment.
The device can provide a full cholesterol assessment, in addition, height, weight and blood pressure can be measured, this enables PocDoc® to calculate a BMI, heart age score and a QRISK3 score in real time which advises the person of risk of a primary CVD event within the next ten years.
If a user has already experienced a CVD event, they do not receive a QRISK3 score and are referred for support at a different stage of the process.
Using PocDoc® as part of a healthy heart check is an easier, more accessible and cost-effective way to access cholesterol testing.
Examples of some of the sessions carried out:
- Womens fitness centre– 149 women tested 27 (18%) referred to GP
- Womens centre – 25 women tested, 16 (64%) referred to GP
- Rural GP surgery (male and female) 19 tested, 18 (95%) referred to GP
- GP surgery (male and female) 14 tested, 8 (57%) referred to GP
Criteria used for referral:
- Total cholesterol equal to or greater than 7mmol/L for primary prevention (PP) patients (no previous heart attack or stroke)
- nonHDL cholesterol equal to or greater the 2.5mmol/L for secondary prevention (SP) patients (previous heart attack or stroke)
- Raised blood pressure, three readings were taken if BP was raised
- QRISK3 score equal to or greater than 10% (Risk of having a heart attack/stroke in the next ten years)
- Over 5000 patients have had a healthy heart check with PocDoc® including over 500 personnel from Cleveland Police
- 30% of patients were referred to their GP with a referral letter for further healthcare advice
- Additional conversations around engaging with healthcare services and having a high QRISK3 score. The healthy heart checks raised awareness of CVD conditions and the team were able to take time to explain what the results meant
- As a PocDoc® healthy heart check is undertaken in the community with instant results it reduces the number of GP appointments as only those with a high cholesterol, raised BP or high QRISK3 score, will be referred to their GP rather than the traditional route of arranging a GP appointment having a venous blood sample taken, awaiting results then returning to the surgery if scores are high
- The speed of results and ability to undertake testing out of surgery reduces the burden on Primary Care
- Early identification of potential CVD and prevention of this escalating
- Do not need to travel to a GP surgery which can be physically demanding and expensive for certain community groups and thus off-putting
- PocDoc® requires only a finger prick or blood compared to a venous sample in Primary Care
- Outreach teams can visit places where community and hard to reach groups congregate already such as football clubs and community centres
- Access those with cultural challenges in an environment comfortable to them
- Some people have problems accessing their GP, this reduces the burden on GP surgeries for routine cholesterol tests
HI NENC have supported the inventor by:
- Contacting organisations to offer healthy heart checks using our networks and contacts within the region
- Evaluating the device and identifying improvements
- Supporting and coaching teams to run healthy heart checks using PocDoc®
- Facilitating healthy heart check sessions
Harnessing information from another HI NENC programme of work – Innovation for Healthcare Inequalities Programme (InHIP) – which informed priorities on hard to reach groups and communities.
As such, Health Innovation NENC have been instrumental in sharing learnings and results through the entire network.
As a result of this, our approach is being considered by an additional 3 ICS’ as a new approach to CVD prevention in the community and areas of Health Inequality.
Further, directly as a result sharing learnings from our work with POCDOC, 1 ICS has already confirmed it would like to adopt our approach (and technology) to lead the CVD screening in their area.
Through insights with our communities, we know that for some women there are barriers to accessing traditional health services. Because of this, in Middlesbrough we are offering a healthy heart check service to women in community locations using innovative cholesterol test PocDoc® . This approach helps to remove barriers by providing tests in a welcoming and safe space. Testament to this collaborative partnership, we are thrilled to be shortlisted alongside PocDoc® and partners in the HSJ Digital Awards, for our support in scaling up the use of the device.