Facilitators and barriers to atrial fibrillation screening in primary care: a qualitative descriptive study of GPs in primary care in the Republic of Ireland

Abstract

Background:Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. Atrial fibrillation is often asymptomatic making it difficult to diagnose. Globally, stroke is a leading cause of morbidity and mortality. Opportunistic atrial fibrillation screening has been recommended in clinical practice within Ireland and internationally, the optimal mode and location remains under investigation. Currently, there is no formal atrial fibrillation screening programme. Primary care has been proposed as a suitable setting.Aim:This study aimed to identify the facilitators and barriers to atrial fibrillation screening in primary care from the perspective of general practitioners (GPs).Design and setting:A qualitative descriptive study design was adopted. 54 GPs were invited from 25 practices insouthern Ireland to participate in individual interviews at their practices, rural and urban.MethodA topic guide was developed to guide the interview content towards identification of facilitators and barriers to atrial fibrillation screening. The interviews were conducted in-person, audio-recorded, transcribed verbatim and analysed using framework analysis.Results and conclusionEight GPs from five practices participated in an interview. Three GPs, two male and one female, were recruited from two rural practices and five GPs, two male and three female, were recruited from three urban practices. All eight GPs expressed a willingness to engage in atrial fibrillation screening. Time pressures and the need for additional staff to support were identified as barriers. Programme structure and patient awareness campaigns/education wereidentified as facilitators.The results have been integrated into a pilot primary care-based screening programme for atrial fibrillation.