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. 2022 Oct 3;3(4):570-577.
doi: 10.1093/ehjdh/ztac055. eCollection 2022 Dec.

Regional implementation of atrial fibrillation screening: benefits and pitfalls

Luc J H J Theunissen  1   2   3 , Reyan B E M Abdalrahim  1   3 , Lukas R C Dekker  1   3   4 , Eric J M Thijssen  2 , Sylvie F A M S de Jong  5 , Peter E Polak  6 , Pepijn H van de Voort  4 , Geert Smits  7 , Karin Scheele  7 , Annelies Lucas  8 , Dennis P A van Veghel  1   4 , Henricus-Paul Cremers  1 , Jeroen A A van de Pol  1   3 , Hareld M C Kemps  1   2   9
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Regional implementation of atrial fibrillation screening: benefits and pitfalls

Luc J H J Theunissen et al. Eur Heart J Digit Health. .

Abstract

Aims: Despite general awareness that screening for atrial fibrillation (AF) could reduce health hazards, large-scale implementation is lagging behind technological developments. As the successful implementation of a screening programme remains challenging, this study aims to identify facilitating and inhibiting factors from healthcare providers' perspectives.

Methods and results: A mixed-methods approach was used to gather data among practice nurses in primary care in the southern region of the Netherlands to evaluate the implementation of an ongoing single-lead electrocardiogram (ECG)-based AF screening programme. Potential facilitating and inhibiting factors were evaluated using online questionnaires (N = 74/75%) and 14 (of 24) semi-structured in-depth interviews (58.3%). All analyses were performed using SPSS 26.0. In total, 16 682 screenings were performed on an eligible population of 64 000, and 100 new AF cases were detected. Facilitating factors included 'receiving clear instructions' (mean ± SD; 4.12 ± 1.05), 'easy use of the ECG-based device' (4.58 ± 0.68), and 'patient satisfaction' (4.22 ± 0.65). Inhibiting factors were 'time availability' (3.20 ± 1.10), 'insufficient feedback to the practice nurse' (2.15 ± 0.89), 'absence of coordination' (54%), and the 'lack of fitting policy' (32%).

Conclusion: Large-scale regional implementation of an AF screening programme in primary care resulted in a low participation of all eligible patients. Based on the perceived barriers by healthcare providers, future AF screening programmes should create preconditions to fit the intervention into daily routines, appointing an overall project lead and a General Practitioner (GP) as a coordinator within every GP practice.

Keywords: Atrial fibrillation; Evaluation; Screening programme; Single-lead-handheld ECG-based screening device.

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Conflict of interest statement

Conflict of interest: Despite the funding of the single-lead ECG-based devices by Bayer and Boehringer Ingelheim, these pharmaceutical companies were not involved in the implementation or evaluation of the screening programme, and they had no involvement in evaluating and analysing the data or writing this manuscript. The authors declare there were no further conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flowchart detailing the GP practices and practice nurses that participated in the screening and the evaluation of the implementation of the screening.
See this image and copyright information in PMC

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