- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05987670
Triple Cardiovascular Disease Detection With an Artificial Intelligence-enabled Stethoscope (TRICORDER)
Heart failure (HF) is a condition in which the heart cannot pump blood adequately. It is increasingly common, consumes 4% of the UK National Health Service (NHS) budget and is deadlier than most cancers. Early diagnosis and treatment of HF improves quality of life and survival. Unacceptably, 80% of patients have their HF diagnosed only when very unwell, requiring an emergency hospital admission, with worse survival and higher treatment costs to the NHS. This is largely because General Practitioners (GPs) have no easy-to-use tools to check for suspected HF, with patients having to rely on a long and rarely completed diagnostic pathway involving blood tests and hospital assessment.
The investigators have previously demonstrated that an artificial intelligence-enabled stethoscope (AI-stethoscope) can detect HF in 15 seconds with 92% accuracy (regardless of age, gender or ethnicity) - even before patients develop symptoms. While the GP uses the stethoscope, it records the heart sounds and electrical activity, and uses inbuilt artificial intelligence to detect HF.
The goal of this clinical trial is to determine the clinical and cost-effectiveness of providing primary care teams with the AI-stethoscope for the detection of heart failure. The main questions it aims to answer are if provision of the AI-stethoscope:
- Increases overall detection of heart failure
- Reduces the proportion of patients being diagnosed with heart failure following an emergency hospital admission
- Reduces healthcare system costs
200 primary care practices across North West London and North Wales, UK, will be recruited to a cluster randomised controlled trial, meaning half of the primary care practices will be randomly assigned to have AI-stethoscopes for use in direct clinical care, and half will not. Researchers will compare clinical and cost outcomes between the groups.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Mihir Kelshiker, MD
- Phone Number: 020 7589 5111
- Email: mihir.kelshiker10@imperial.ac.uk
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Primary care practices that care for adult patients and have the ability to request natriuretic peptide blood testing
- Primary care practices within the NIHR North West London Clinical Research Network or Betsi Cadwaladr University Health Board.
Exclusion Criteria:
- Poor WiFi and/or mobile data connectivity within primary care consulting rooms
- No face-to-face patient consultations
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control
Usual care
|
|
Experimental: Intervention
Receive 3-6 AI-stethoscopes (Eko DUO, Eko Health Inc, CA, USA) including artificial intelligence software for detection of:
|
Clinicians at practices in the intervention arm will be provided with one session of in-person training in use of the AI-stethoscope within 2 weeks of randomisation, including
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of heart failure (co-primary)
Time Frame: 24 months
|
Difference in incidence of coded new diagnoses of heart failure (HF)
|
24 months
|
Ratio of route to diagnosis of heart failure (co-primary) between emergency and community-based pathways
Time Frame: 24 months
|
Difference in ratio of the incidence of coded diagnoses of HF via hospital admission-based versus community-based pathways.
|
24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of atrial fibrillation
Time Frame: 24 months
|
New coded diagnoses of atrial fibrillation (AF)
|
24 months
|
Incidence of valvular heart disease
Time Frame: 24 months
|
New coded diagnoses of valvular heart disease (VHD)
|
24 months
|
Cost-consequence (AF)
Time Frame: 24 months
|
Cost-consequence analysis (form of health economic evaluation) for diagnosis of atrial fibrillation, stratified by route to diagnosis.
Presented in pounds sterling.
|
24 months
|
Cost-consequence (HFrEF)
Time Frame: 24 months
|
Cost-consequence analysis (form of health economic evaluation) for diagnosis of HFrEF, stratified by route to diagnosis.
Presented in pounds sterling.
|
24 months
|
Cost-consequence (VHD)
Time Frame: 24 months
|
Cost-consequence analysis (form of health economic evaluation) for diagnosis of VHD, stratified by route to diagnosis.
Presented in pounds sterling.
|
24 months
|
Health service utilisation
Time Frame: 24 months
|
Health service utilisation for diagnostics e.g.
rates of request for echocardiography, electrocardiography, primary care appointments.
Collected from NHS organisation business intelligence repositories and UK Trusted Research Environments.
|
24 months
|
Proportion of patients prescribed guideline-directed medical therapy
Time Frame: 24 months
|
Proportion of patients prescribedguideline-directed medical therapy (HF, AF, VHD)
|
24 months
|
Device therapy
Time Frame: 24 months
|
New implantation of cardiac resynchronisation therapy (CRT) and/or implantable cardioverter-defibrillator (ICD)
|
24 months
|
Uptake and utilisation
Time Frame: 24 months
|
Differential rates of uptake and utilisation of AI-stethoscope in primary care
|
24 months
|
Determinants of uptake and utilisation
Time Frame: 24 months
|
Determinants of utilisation of AI-stethoscope in primary care (clinician questionnaires)
|
24 months
|
Patient quality of life
Time Frame: 24 months
|
Healthy Days at Home (patient-level analysis)
|
24 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sensitivity analysis
Time Frame: 24 months
|
Patient-level sensitivity analyses will be performed for patients with abnormal Eko DUO predictions for HF, to identify direct associations between AI-stethoscope predictions and specific diagnostic codes for HF, AF and VHD
|
24 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Nicholas S Peters, MD, Imperial College London
Publications and helpful links
General Publications
- Bachtiger P, Petri CF, Scott FE, Ri Park S, Kelshiker MA, Sahemey HK, Dumea B, Alquero R, Padam PS, Hatrick IR, Ali A, Ribeiro M, Cheung WS, Bual N, Rana B, Shun-Shin M, Kramer DB, Fragoyannis A, Keene D, Plymen CM, Peters NS. Point-of-care screening for heart failure with reduced ejection fraction using artificial intelligence during ECG-enabled stethoscope examination in London, UK: a prospective, observational, multicentre study. Lancet Digit Health. 2022 Feb;4(2):e117-e125. doi: 10.1016/S2589-7500(21)00256-9. Epub 2022 Jan 5.
- Bachtiger P, Kelshiker MA, Petri CF, Gandhi M, Shah M, Kamalati T, Khan SA, Hooper G, Stephens J, Alrumayh A, Barton C, Kramer DB, Plymen CM, Peters NS. Survival and health economic outcomes in heart failure diagnosed at hospital admission versus community settings: a propensity-matched analysis. BMJ Health Care Inform. 2023 Mar;30(1):e100718. doi: 10.1136/bmjhci-2022-100718.
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 22HH8045
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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