Abstract
ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.
Highlights
Atrial fibrillation (AF) is a common arrhythmia affecting around 10% of people aged over 65 in the UK1 and is associated with an increased risk of stroke which is substantially reduced by anticoagulation.[2]
Individuals aged over 65 years both with and without a coded diagnosis of atrial fibrillation (AF) in their medical records were invited by their general practitioner (GP) to a single nurse-led screening visit to test the accuracy of several devices for the detection of AF
A number of themes emerged relating to their (1) understanding of AF, (2) attitudes to screening, (3) attitudes to the screening devices tested during the SAFETY study and (4) their attitudes to undergoing prolonged screening
Summary
Atrial fibrillation (AF) is a common arrhythmia affecting around 10% of people aged over 65 in the UK1 and is associated with an increased risk of stroke which is substantially reduced by anticoagulation.[2] Across. It is estimated that 425 000 people are living with undiagnosed AF,[3] and there has been much recent debate about screening for AF.[4] The European Cardiac Society currently recommends opportunistic screening in patients aged >65 and consideration of Strengths and limitations of this study. ►► A strength of this study is that all the interviews were conducted by a single researcher, ensuring consistency. ►► The study had good representation in terms of a typical screening population aged over 65 years the high proportion of female participants may have affected the results. ►► All of the participants had taken part in the Screening for Atrial Fibrillation using Economical and Accurate TechnologY trial and those not wishing to be screened for atrial fibrillation (AF) may have had different views
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