Annual foot screening could help spot heart irregularities in people with diabetes

This National Heart Month (February) leading podiatrists across the North East are calling for people with diabetes to go for their annual footcheck, as findings show it could prevent the risk of stroke.

The call comes the results of a three-month pilot foot pulse-test project aimed at increasing the diagnosis of Atrial Fibrillation (AF) identified a number 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 over 65 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 scheme, revealed that the region’s NHS 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 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 I’ve worked with across County Durham and Darlington have been very tuned into the program and recognize it as their clinical responsibility to help spot AF. The pilot 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, 5,000 diabetic patients had their feet pulse-tested across the North East. 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 Type2 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 program 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, NHSE & Consultant Diabetologist at City Hospitals, Sunderland, 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 & podiatry specialists across the region in order to encourage further adoption of the foot pulse-test.

The project has also gained recognition from the AF Association who honored the program 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 organized by the British Heart Foundation. National Heart Month encourages people to make small changes towards a healthier lifestyle.