Abstract
BackgroundScreening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines. The Atrial Fibrillation Screen, Management And guideline-Recommended Therapy (AF-SMART) studies of opportunistic AF screening in 16 metropolitan and rural general practices were conducted from November 2016–June 2019. These studies trialled custom-designed eHealth tools to support all stages of AF screening in general practice.MethodsA realist evaluation of the AF-SMART studies, which aimed to explain the circumstances in which the program worked (or not) to increase the proportion of people screened for AF. The initial program theory was based on our previous research, policy documents and screening studies. To test this, we conducted 45 semi-structured interviews with general practitioners (GPs), nurses and practice managers across all participating practices, and collected observational and quantitative screening data. These data were analysed and interpreted to refine the program theory.ResultsGPs/nurses liked the eHealth tools, although technical problems sometimes disrupted screening. Time was the main barrier to screening for GPs/nurses, so systems need to be very efficient. Practices with leadership from a senior GP ‘screening champion’ had broader uptake, especially from the nursing team. Providing regular feedback on screening data was beneficial for quality improvement and motivation. Clear protocols for follow-up of abnormal results were required for successful nurse-led screening in a hierarchical system. Participation in the program had broader benefits of improving AF knowledge and raising the profile of cardiovascular health in the practice. Screening for a shorter, more intense period (eg during influenza vaccination) worked well for practices where sufficient staff time was allocated.ConclusionsIntroducing an AF screening program is likely to be successful in contexts where there is a senior GP ‘screening champion’, a clear protocol exists for abnormal results, and there is regular data reporting to staff. These contexts link to mechanisms around motivation, leadership, empowerment of nurses, and efficient screening systems. The contexts and mechanisms contribute to the longer-term outcomes of increasing the proportion of people screened and treated for AF, which is recommended by guidelines as a key strategy for the prevention of AF-related stroke.Trial registrationsAF SMART (metropolitan): ACTRN12616000850471 (Australia New Zealand Clinical Trials Registry).AF SMART II (rural): ACTRN12618000004268 (Australia New Zealand Clinical Trials Registry).
Highlights
Screening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines
Our previous studies showed both General practitioner (GP) and nurses liked screening with the Smartphone electrocardiogram (iECG) device, but that there were several key barriers, including time pressure, and lack of funding/remuneration for screening [21, 22]
Our initial program theory was that by providing a novel screening device together with integrated electronic tools and financial incentives to support all stages of screening, the program will be more systematic and efficient, and time-poor GPs and nurses will opportunistically screen a higher proportion of eligible patients aged ≥65 years seen in the practice (Fig. 1)
Summary
Screening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines. The Atrial Fibrillation Screen, Management And guideline-Recommended Therapy (AF-SMART) studies of opportunistic AF screening in 16 metropolitan and rural general practices were conducted from November 2016–June 2019. AFrelated stroke is highly preventable with appropriate oral anticoagulant (OAC) treatment. A number of guidelines and expert consensus statements recommend opportunistic single-timepoint AF screening for people aged ≥65 years [1, 3, 5]. These guidelines generally advocate screening by pulse palpation or single-lead electrocardiogram (ECG). A survey of general practitioners (GPs) published in The Economist found that respondents in Australia had only screened 11% of eligible patients in the previous fortnight [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
