Abstract
BackgroundAtrial fibrillation (AF) and other arrhythmias are prevalent and often encountered by general practitioners (GPs). In response to the growing prevalence and to assist practitioners in the diagnosis and management of AF, the Cardiac Society of Australia & New Zealand and Heart Foundation of Australia published the first Australian AF Guidelines in 2018. We aimed to examine (a) the proportion of GPs who performed any form of AF screening and identify the methods they applied, (b) GPs’ awareness of the AF Guidelines and approaches to arrhythmia screening, (c) the roles of conventional 12-lead ECG and mobile health devices, and (d) GPs’ confidence in ECG interpretation and need for training.MethodsA cross-sectional online survey titled “GPs Screen their patients for Atrial Fibrillation and othEr aRrhythmia (GPSAFER)” was conducted from October 2018 to March 2019. The participants were recruited via various GP networks across Australia. Ethics approval was granted by The University of Sydney.ResultsA total of 463 surveys were completed. Many GPs (394/463, 85.1%, 95% CI 81.5–88.2%) performed some forms of AF screening and applied at least one AF screening method, most frequently pulse palpation (389/463, 84.0%). Some (299/463, 64.6%) GPs considered assessing their patients for other arrhythmias (237/299, 79.3% for complete heart block and 236/299, 78.9% for long-QT). Most GPs (424/463, 91.6%) were not using mobile ECG devices in their practice but some (147/463, 31.7%) were contemplating it. One third (175/463, 37.8%) of GPs were aware of the Australian AF Guidelines; those aware were more likely to perform AF screening (98.9% vs 76.7%, p < 0.001). Factors significantly and positively associated with AF screening were “awareness of the AF Guidelines” (p < 0.001), “number of years working in general practice” (p < 0.001), and “confidence in ECG interpretation of AF” (p = 0.003). Most GPs reported that they were very or extremely confident in interpreting AF (381/463, 82.3%) and complete heart block (266/463, 57.5%). Many GPs (349/463, 75.4%) would like to receive online ECG interpretation training.ConclusionsAssessment of arrhythmias is common in general practice and GPs are open to further training in ECG interpretation and using mobile ECG devices to aid their clinical practice. Increasing awareness of AF Guidelines and improving confidence in ECG interpretation may increase AF screening.
Highlights
Atrial fibrillation (AF) and other arrhythmias are prevalent and often encountered by general practitioners (GPs)
In response to the growing prevalence and gaps in treatment and to assist Australian practitioners in the diagnosis and management of AF, in 2018 the National Heart Foundation of Australia (NHFA) and Cardiac Society of Australia and New Zealand (CSANZ) published the first Australian AF Guidelines [11]: the Guidelines recommend that “Opportunistic annual screening for AF in general practice in patients aged 65 years or more is accomplished by pulse palpation, followed by an electrocardiogram (ECG), or by an ECG rhythm strip using a handheld ECG
Multivariate logistic regression analysis showed that factors significantly and positively associated with AF screening were “awareness of AF Guidelines” (p < 0.001), “number of years working in general practice” (p < 0.001), and “confidence in ECG interpretation of AF” (p = 0.003)
Summary
Atrial fibrillation (AF) and other arrhythmias are prevalent and often encountered by general practitioners (GPs). In response to the growing prevalence and gaps in treatment and to assist Australian practitioners in the diagnosis and management of AF, in 2018 the National Heart Foundation of Australia (NHFA) and Cardiac Society of Australia and New Zealand (CSANZ) published the first Australian AF Guidelines [11]: the Guidelines recommend that “Opportunistic annual screening for AF in general practice in patients aged 65 years or more is accomplished by pulse palpation, followed by an electrocardiogram (ECG) (if irregular), or by an ECG rhythm strip using a handheld ECG. Devices that provide a medicalquality ECG trace are preferred to pulse-taking or pulsebased devices (i.e. photoplethysmography and blood pressure oscillometry) for screening, because an ECG is required to confirm the diagnosis”
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