Experiences with screening for atrial fibrillation: a qualitative study in general practice

Abstract

Background/IntroductionGuidelines recommend screening for atrial fibrillation (AF). Currently screening is not considered standard care among general practitioners (GPs).AimTo explore the experiences of primary care workers with different methods of screening for AF and with implementation in daily practice.Design & settingA qualitative study using semi-structured interviews with GPs, nurses and assistants, experienced with implementation of different methods of screening.MethodTwo independent researchers audio recorded and analysed interviews using a thematic approach. They asked participants about their experiences with the different methods used for screening AF and which obstacles they faced with implementing screening in daily practice.ResultsIn total 15 GPs, nurse practitioners and assistants from 7 different practices were interviewed. The GP’s office is suited for screening for AF, which ideally should be integrated with standard care. Participants considered pulse palpation, automated sphygmomanometer with AF detection and single-lead electrocardiography (ECG) as practical tests. Participants trusted pulse palpation over the algorithm of the devices. The follow-up of a positive test with a time-consuming 12-lead ECG hindered integration of screening. The single-lead ECG device reduces the need for immediate follow-up, because it can record a rhythm strip. The extra workload of screening and lack of financial coverage form obstacles for implementation.ConclusionsPulse palpation, automated blood pressure measure monitors with AF detection and single-lead ECGs might facilitate screening in a GP setting. When implementing screening, focus should lie on how to avoid disruption of consultation hours by unplanned 12-lead ECGs.

Staff acceptability and patient usability of a self-screening kiosk for atrial fibrillation in general practice waiting rooms

“…Previous opportunistic screening approaches in general practice have focussed on staff-led screening through pulse palpation, or hand-held devices 9,[14][15][16][17] . Only one other study, SAFE-2-SCREEN, examined patient-led screening for AF in GP waiting rooms.…”

“…Previous opportunistic screening approaches in general practice have focused on staff-led screening through pulse palpation or hand-held devices. 9 , 14 , 15 , 16 , 17 Only 1 other study, SAFE-2-SCREEN, examined patient-led screening for AF in GP waiting rooms. The SAFE-2-SCREEN study screened a large number of patients (n = 28,340, mean age = 51.9) and achieved a detection rate of 0.68%, 18 , 19 which is in line with the known detection rate of 0.41% for people <65 years.…”

“…To date, interventions to improve AF screening rates in general practice have focussed on the use of screening devices during doctor or nurse consultations, or by receptionists. However, time constraints have been identified as the main barrier for implementing staff-led screening [6][7][8][9] . To overcome time barriers, a possible approach is for patients to self-screen in GP waiting rooms prior to their consultation 10 .…”

“…However, time constraints have been identified as the main barrier for implementing staff-led screening. 6 , 7 , 8 , 9 To overcome time barriers, a possible approach is for patients to self-screen in GP waiting rooms prior to their consultation. 10 A self-screening approach was trialed in 2020–2021 in the AF SELF SMART study.…”

Screening of Atrial Fibrillation in Dental Practices: a qualitative feasibility study

“…25 Indeed, a systematic review concluded that although screening for AF is bene cial, targeted screening is more costeffective than systematic screening. 26 Uittenbogaart et al (2022) found that clinicians like general practitioners prefer to use hand-held devices for screening of AF over methods like palpating a patient's pulse, as the reading can be saved or stored. 27 A qualitative study interviewing pharmacists using focus groups concluded that AF screening should be incorporated into general practices and prioritised for highrisk patients; 25 another qualitative research article also highlighted the importance of screening high risk patients.…”