ObjectivesTo explore ways to enhance the design of risk factor management and weight-loss services for people with overweight/obesity and atrial fibrillation (AF).BackgroundAF is the most common cardiac arrhythmia, with serious consequences for health and quality of life. Some evidence indicates weight reduction in people with AF and overweight/obesity may improve symptoms. This population may require additional support with weight management due to factors associated with ageing and health.DesignQualitative investigation based on semi-structured interviews.Methods12 adult participants (4 female, 8 male) with diagnosed AF and a current or previous body mass index >27 kg/m2were recruited at a large tertiary cardiac referral centre in southern England between September 2020 and January 2021. Participants completed quality of life and AF symptom questionnaires using Think-Aloud technique and semi-structured interviews relating to their weight management experiences, needs and preferences. Interviews were audio recorded and analysed thematically using the Capability, Opportunity and Motivation-Behaviour model as a theoretical framework.ResultsThree main themes were identified.Being out of rhythmexplores the psychological and physical impact of AF on weight management;doing the right thingdiscusses participants’ weight management experiences andbroaching the subjectexplores participants’ perspectives on weight management conversations with clinicians.ConclusionsThere was dissatisfaction with the weight management advice received from healthcare professionals including cardiologists. Participants wanted open, non-judgemental discussion of cardiac health implications of overweight/obesity supported by referral to weight management services. Improved communication including research findings regarding the benefits of weight loss as a factor in AF management might increase motivation to adhere to weight-loss advice in this population.

Background: About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim: The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy of identifying visual impairment in hyperacute strokes were developed and evaluated. Methods: The educational package was developed through focus groups. The pilot study screened patients with suspected strokes in prehospital settings; the V-FAST tool was used with 43 of these patients. Each participant was also assessed in hospital using the National Institutes of Health Stroke Scale (NIHSS) and the score compared to V-FAST screening results to determine sensitivity and specificity. Results: The education package includes detailed instructions with video. In the pilot study, V-FAST detected visual impairment in 75.9% of FAST-positive and 80% of FAST-negative strokes. Sensitivity and specificity compared to NIHSS were 85.7% and 42.1% respectively. Conclusion: V-FAST has good sensitivity to detect vision impairment when screening for possible strokes. The added education package facilitates greater knowledge and understanding of potential visual problems caused by stroke.