A Grocery Cart That May Just Save Your LIfe!

Going to the grocery store is a dredded chore for so many people! What if the grocery cart you push just might save your life?

It could be a trip to the grocery store that saves your life. Grocery carts are being used to diagnose atrial fibrillation, which can then be treated to avoid strokes that can be disabling or even fatal.  Today, the study is being presented at ACNAP 2023, a scientific meeting of the European Society of Cardiology (ESC).1 "

"This study shows the potential of taking health checks to the masses without disrupting daily routines," said study author Professor Ian Jones of Liverpool John Moores University, UK. "Over the course of two months, we identified 39 patients who were unaware that they had atrial fibrillation. That's 39 people at greater risk of stroke who received a cardiologist appointment."

Atrial fibrillation is the most common heart rhythm problem. It affects more than 40 million people all over the world.2 Atrial fibrillation makes a person five times more likely to have a stroke. These strokes often kill or leave people unable to move. Anticoagulation greatly lowers the risk, but many people only find out they have atrial fibrillation after they have a stroke.3 Screening programs are needed to find people with the disease so they can get medicine to avoid it.

The SHOPS-AF study looked into whether putting electrocardiogram (ECG) sensors in the handles of supermarket carts could help find shoppers with atrial fibrillation (see picture).4,5: During the two-month study, ten shopping carts with sensors in the handles were used in four Liverpool stores with pharmacies.

Shoppers were asked to use a modified cart and hold the wheel for at least 60 seconds. If the monitor didn't find an irregular heartbeat, it would light up green. A researcher checked these people's pulses by hand to make sure they didn't have atrial fibrillation. If the heartbeat was not normal, the sensor would light up red. The pharmacist then checked the person's pulse by hand and took another sensor reading using a bar that wasn't linked to a cart while the person stood still. The cardiologist in charge of the study looked at the ECG data of the people who had a red light and/or an irregular heartbeat. Participants were told the results, which were: 1) no atrial fibrillation; 2) unclear ECG with an offer to repeat the measurement; or 3) confirmed atrial fibrillation with a cardiologist appointment within two weeks.

There were 2,155 people who used a shopping cart. There were ECG results for 220 people who had either a red light on the monitor or an irregular pulse, both of which were signs of atrial fibrillation. The study cardiologist looked at the ECGs of all the subjects and found that 115 didn't have any signs of atrial fibrillation, 46 were unclear, and 59 did have atrial fibrillation. The 59 people with atrial fibrillation had an average age of 74, and 43% were women. Twenty of them already knew they had atrial fibrillation, but the other 39 had never been told.

To figure out how well this way of screening works, the researchers did three things: 1) Not counting any of the 46 unclear ECGs, 2) Assuming that all the unclear ECGs were atrial fibrillation, and 3) Assuming that none of the unclear ECGs were atrial fibrillation. This showed that the sensor was sensitive between 0.70 and 0.93 and specific between 0.15 and 0.97. This led to a positive predictive value of 0.24 to 0.56, which means that only one-quarter to one-half of those who were found to have atrial fibrillation by the sensor and/or physical pulse check actually had the condition (i.e., there were a lot of false positives). The negative prediction value was between 0.55 and 1.00, which means that this method would miss about half of the real cases of atrial fibrillation (false negatives).

Professor Jones said: "Nearly two-thirds of the shoppers we approached were happy to use a trolley, and the vast majority of those who declined were in a rush rather than wary of being monitored. This 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. For example, having a designated position on the bar to hold onto, as hand movement interfered with the readings. In addition, ESC Guidelines require just a 30-second ECG to diagnose atrial fibrillation,2 so we aim to find a sensor that will halve the time shoppers need to continuously hold the bar." He concluded: "Checking for atrial fibrillation while people do their regular shopping holds promise for preventing strokes and saving lives. A crucial aspect is providing immediate access to a health professional who can explain the findings and refer patients on for confirmatory tests and medication if needed."

European Society of Cardiology. "Grocery store carts set to help diagnose common heart rhythm disorder and prevent stroke." ScienceDaily. ScienceDaily, 23 June 2023. <www.sciencedaily.com/releases/2023/06/230623105504.htm>.

WNCTimes by Marjorie Farrington