Annual Foot-Check Could Help Identify Heart Irregularities in Diabetic Patients

23rd February 2018

February is National Heart Month and leading podiatrists across the North East region are calling for people with diabetes to go for their annual foot check, as findings show it could prevent the risk of stroke.

The call comes from the result findings of a three-month foot pulse-test Pilot Study aimed at increasing the diagnosis of Atrial Fibrillation (AF), which identified a cohort of patients with previously undiagnosed AF.

AF is a common heart condition causing an irregular heart rate. It affects around one million people in the UK with a further 474,000 estimated to be living with undiagnosed AF. Almost one in ten people aged 65 years or over, are affected by the condition which commonly displays no symptoms. Without treatment those living with AF are at increased risk of suffering a stroke costing the NHS on average £23,315 per patient.

A Report following the Podiatry and Atrial Fibrillation Case Finding Project, revealed that NHS organisations from across the region could benefit from potential cost savings in excess of £500,000.

During the initiative, 45 podiatrists from across North Durham; Darlington; and Durham Dales Easington and Sedgefield CCGs were trained to spot heart irregularities when taking pulse readings of diabetic patients’ feet during their annual foot screening appointments. This means more podiatrists from the region are now upskilled in this potentially life-saving check.

Leading the Podiatry and Atrial Fibrillation Case Finding Project Linda Hicks, Podiatrist at Country Durham and Darlington NHS Foundation Trust, said: “The feet can provide an excellent indication of a patients’ wider health and can be the first sign of a potentially serious problem that, if caught early, could save your life. Patients with diabetes have a much greater risk of developing problems with their feet which is why we want to stress the importance of their annual foot check.

“With podiatry staff already taking pulses in patients’ feet they are well placed to help identify patients with pulse irregularities. The podiatry staff that I’ve worked with across the County Durham and Darlington area have been very tuned into the Project and recognise it as their clinical responsibility to help identify undiagnosed AF. The Pilot Study has been an excellent opportunity to raise awareness of the condition amongst patients and healthcare professionals alike and training continues to be rolled out across the region.”

Over the course of the three-month Pilot Study, 5,000 diabetic patients had their feet pulse-tested across the North East region. The Project uncovered that for every 500 patients who had their feet checked, one new case of AF could be identified.

Philip Teasdale, age 57, from Bishop Auckland was diagnosed with Type 2 Diabetes. Following an initial check-up with his GP, Philip was asked to make an appointment with his GP surgery’s podiatrist.

Philip said: “I was invited to see the podiatrist the same day as my GP appointment which was very convenient. Upon checking the pulses in my feet with ultrasound, I was informed that I had an irregular heartbeat. At this point I was referred to the practice nurse and then back to my GP, Dr. Waller, who kept me informed, explained the risks and discussed my options for treatment.

“The process of the foot pulse-test was quick and painless and without this early diagnosis and subsequent treatment my condition might have gone undetected for far longer and could have led to more complex health complications further down the line.

“I am now being prescribed Warfarin tablets and I’m being monitored by the anticoagulant clinic and would encourage others with diabetes to book an appointment with a podiatrist as a precaution and to help better manage their conditions.”

Public Health England estimates that 1.36 million people in England are living with AF, giving a current prevalence in the population of around 2.4% – with just 1.6% of those having been diagnosed.

The Podiatry and AF Case Finding Project is part of a wider AF programme run by the Academic Health Science Network for the North East and North Cumbria (AHSN NENC) in conjunction with the Northern England Clinical Networks. It aims to reduce the number of strokes and deaths in the region by treating AF as early as possible.

Dr Rahul Nayar, Chair of the Northern Diabetes Footcare Network; Diabetes Clinical Lead for Northern England Clinical Networks; NHS England and Consultant Diabetologist at City Hospitals Sunderland NHS Foundation Trust said:

“People with diabetes are invited on an annual basis for routine health checks for their feet to ensure the nerves and blood vessels are healthy, this additional check for a person’s heart rhythm can performed at the same time. It’s a simple and straightforward process that forms part of the daily routine of all podiatry staff and can help to spot any pulse irregularities early on. This is a vital screening process as heart problems are unfortunately two to three times more common in people with diabetes; so any simple process that picks up a potential problem quickly can save lives.

“Going forward through the Northern Diabetes Footcare Network we plan to engage with more managers and podiatry specialists across the North East and North Cumbria region in order to encourage further adoption of the foot pulse-test.”

The Project has also gained recognition from the AF Association who honoured the programme of work with its Healthcare Pioneers Award – a prestigious accolade given to examples of truly innovative best practice covering identification, diagnosis, management, treatment and care of patients with Atrial Fibrillation.

National Heart Month takes place every February and is organised by the British Heart Foundation. National Heart Month encourages people to make small changes towards a healthier lifestyle. For more information visit: https://www.bhf.org.uk/heart-health/preventing-heart-disease/heart-month1

Order your free ‘How to Spot a Foot Attack’ resource online at: https://shop.diabetes.org.uk/store/managing-your-diabetes/information/putting-feet-first/how-to-spot-a-foot-attack.aspx

For more information on the AHSN NENC’s AF Programme visit: http://www.ahsn-nenc.org.uk/programmes/atrial-fibrillation/