While Flawed, Afib-Detecting Shopping Carts Show Promise in Early Study

Supermarket shopping carts equipped with ECG sensors provided an opportunity to detect undiagnosed atrial fibrillation (Afib), though kinks first need to be worked out, a pilot study suggested.

In Liverpool, England, shoppers at one of four Sainsbury’s supermarkets were approached about using special shopping carts with MyDiagnostick single-lead ECG sensors in the handles. Nearly 60% of over 3,700 individuals agreed to participate. Ultimately, 39 people (a yield of just under 2%) previously undiagnosed with Afib had suspected Afib flagged and subsequently confirmed by an on-site cardiologist, said Ian Jones, PhD, a senior cardiac nurse at Liverpool John Moores University, and colleagues.

Notably, this initial experience with shopping cart ECGs produced one in five recordings that were nondiagnostic due to movement artifacts while the user was shopping. Artificial intelligence may be helpful to clean ECG data in the future, Jones and colleagues suggested during their presentation at the Association of Cardiovascular Nursing and Allied Professions conference hosted by the European Society of Cardiology (ESC).

“This study shows the potential of taking health checks to the masses without disrupting daily routines,” said Jones in a press release. “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.”

“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,” he added.

Afib is a key risk factor for stroke, yet the clinical benefits of mass screening are unproven in the general population.

The U.S. Preventive Services Task Force continues to withhold endorsement of Afib screening in middle-age and older adults without symptoms and without a history of transient ischemic attack or stroke, citing insufficient evidence that benefits outweigh potential harms — such as the increased risk of major bleeding when starting anticoagulation for screen-detected Afib.

Participating sites in the present study were four Liverpool supermarkets with on-site pharmacy departments.

The shopping carts had ECG sensors that flashed a red X when Afib was suspected. In this case, people with ECGs showing potential Afib were seen by a cardiologist. All participants additionally underwent manual pulse check to assess pulse regularity.

Those with no Afib on the ECG were reassured when they were contacted subsequently.

Jones and team acknowledged that their study was observational, with a convenience sample relying on volunteers.

“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,” Jones said.

His group estimated that the tested approach produced a sensitivity in the 70% to 93% range and a specificity of 15% to 97%. The low specificity is related to false positives due to ECG artifacts, the authors explained.

“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, so we aim to find a sensor that will halve the time shoppers need to continuously hold the bar,” Jones said.

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