Screening for Atrial Fibrillation – A Cross-Sectional Survey of Healthcare Professionals in Primary Care

Abstract

IntroductionScreening for atrial fibrillation (AF) in primary care has been recommended; however, the views of healthcare professionals (HCPs) are not known. This study aimed to determine the opinions of HCP about the feasibility of implementing screening within a primary care setting.MethodsA cross-sectional mixed methods census survey of 418 HCPs from 59 inner-city practices (Nottingham, UK) was conducted between October-December 2014. Postal and web-surveys ascertained data on existing methods, knowledge, skills, attitudes, barriers and facilitators to AF screening using Likert scale and open-ended questions. Responses, categorized according to HCP group, were summarized using proportions, adjusting for clustering by practice, with 95% C.Is and free-text responses using thematic analysis.ResultsAt least one General Practitioner (GP) responded from 48 (81%) practices. There were 212/418 (51%) respondents; 118/229 GPs, 67/129 nurses [50 practice nurses; 17 Nurse Practitioners (NPs)], 27/60 healthcare assistants (HCAs). 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Non-GP HCPs reported having less knowledge about ECG interpretation, diagnosing and treating AF than GPs. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8–20.0); HCAs: 37.0% (21.7–55.5); nurses: 44.0% (30.0–59.0); NPs 41.2% (21.9–63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator.ConclusionInner-city general practices were found to have adequate access to resources for AF screening. There is enthusiasm by non-GP HCPs to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented within primary care.

Screening of older patients for atrial fibrillation in general practice: Current evidence and its implications for future practice

“…A follow-up study investigating AF screening by nurses using an iECG device in a practice setting again highlighted practice-specific barriers that were mainly related to staff time and funding [40]. Another recent study surveyed the views of healthcare practitioners in inner-city GP surgeries in Nottingham, UK, to ascertain their readiness for future screening in AF [41]. The majority of practices surveyed were able to perform and interpret ECGs inhouse, but they highlighted the need for additional training.…”

Interpretation of electrocardiograms in primary care

“…Taggar and colleagues also reported enthusiasm by GPs and nurses to up-skill in ECG interpretation. 2 These findings suggest that alternative models to improve accuracy of ECG interpretation warrant consideration, such as the development of validated, evidence-based ECG training programmes for primary care HCPs. The model suggested by Begg and colleagues could still be delivered within primary care using the hub and spoke/confederated working, with hub practices having the role of up-skilled ECG interpretation.…”

“…Few diagnoses are predictably associated with such a dramatic increase in cardiovascular risk and none are so easily identified by a cheap and easily available blood test. 2,3 The clustering of vascular pathologies with diabetes and hypertension makes this burden of disease the greatest challenge for the next generation of patients and doctors.…”

Risk stratification for free

“…Few diagnoses are predictably associated with such a dramatic increase in cardiovascular risk and none are so easily identified by a cheap and easily available blood test. 2,3 The clustering of vascular pathologies with diabetes and hypertension makes this burden of disease the greatest challenge for the next generation of patients and doctors.…”

“…But being able to express these feelings and mention faith to a supportive healthcare professional in a safe and confidential environment helped develop understanding and trust. 2 For example, I recall explaining why Jesus encouraged secret prayer, explaining the apparent paucity.…”