Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

Abstract

ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care

“…Participants’ concern about having a stroke mediated their unfamiliarity with AF and encouraged them to take part. The novelty of AF is unsurprising as studies find limited awareness of the condition, whether the participants’ relationship to AF is: just at risk;45 being screened for it;27 prior to diagnosis;46 or having it 44 47. Similarly, those with AF report being worried or fearful about their condition,46 47 consider it a serious heart disease48 and overestimate the risk of stroke 49.…”

“…Patient associations which champion AF screening provide important information from the perspective of a motivated minority, but tell us little about the opinions of the wider public 12. If typically positive attitudes to screening programmes apply here,25 26 it seems likely that the public will be enthusiastic about AF screening, as seen in a small-scale study of AF screening trial participants27 and informal reports from a previous AF screening trial 28. However, little is known about the reasons why the public are motivated to participate in AF screening 27 28.…”

“…If typically positive attitudes to screening programmes apply here,25 26 it seems likely that the public will be enthusiastic about AF screening, as seen in a small-scale study of AF screening trial participants27 and informal reports from a previous AF screening trial 28. However, little is known about the reasons why the public are motivated to participate in AF screening 27 28. We aimed to explore why participants in Screening for Atrial Fibrillation using ECG to Reduce stroke (SAFER), an AF screening study, opted to take part.…”

The contribution of intermittent handheld electrocardiogram and continuous electrocardiogram monitoring with an implantable loop recorder to detect incident and recurrent atrial fibrillation during 1 year after coronary artery bypass graft surgery: A prospective cohort study

“…The difference in AF detection rate between the 2 methods could possibly have been smaller if a more extended schedule (ie, daily) for handheld ECG recordings had been used. [17][18][19] AF screening in general 20 and handheld ECG in particular 21 have been proven to be well tolerated, but most probably an extended handheld ECG recording schedule would have been at the expense of patient compliance. 20 In addition, most AF episodes were of short duration and accordingly hard to capture with intermittent ECG monitoring methods.…”

“…[17][18][19] AF screening in general 20 and handheld ECG in particular 21 have been proven to be well tolerated, but most probably an extended handheld ECG recording schedule would have been at the expense of patient compliance. 20 In addition, most AF episodes were of short duration and accordingly hard to capture with intermittent ECG monitoring methods. It is established that continuous ECG monitoring with an ILR captures significantly more paroxysmal episodes of AF than noninvasive modalities, [22][23][24][25] and routine clinical AF classification based on intermittent ECG monitoring poorly reflects AF temporal persistence.…”