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Atrial fibrillation (AF) pilot screening programme in primary care in Ireland: an implementation study protocol
Aileen Callanan1,2, Diarmuid Quinlan3, Susanne O'Sullivan4
1School of Public Health, University College Cork, Cork, Ireland aileen.callanan@ucc.ie.
Insights
Screening for atrial fibrillation (AF) in older adults using mobile ECGs in primary care is feasible. Early AF detection significantly reduces stroke risk, a major public health concern.
Area of Science:
- Cardiology
- Public Health
- Primary Care Medicine
Background:
- Atrial fibrillation (AF) significantly increases stroke risk, contributing to global morbidity and mortality.
- Early detection and treatment of AF can reduce stroke risk by up to two-thirds.
- AF screening is recommended by national cardiovascular policies, but various methods exist.
Purpose of the Study:
- To investigate the acceptability and feasibility of screening for atrial fibrillation in primary care.
- To evaluate the impact of using a handheld mobile ECG device for AF screening.
- To assess the potential of early AF detection in reducing stroke risk.
Main Methods:
- Opportunistic screening of patients aged ≥65 years for AF using the KardiaMobile handheld ECG device in primary care settings in South Ireland.
- Concurrent collection of blood pressure and smoking status data.
- Mixed-method evaluation including a partial economic analysis, anonymised data collection, and qualitative interviews with participants.
Main Results:
- The study aims to screen up to 4000 patients.
- Data collection will involve both quantitative (screening results, patient demographics) and qualitative (interviews) methods.
- A mixed-method approach will provide comprehensive insights into the screening program's effectiveness and patient/clinician experience.
Conclusions:
- The study will provide valuable data on the implementation of AF screening in primary care.
- Findings will inform the development of effective AF screening programs to mitigate stroke risk.
- This research supports the integration of mobile health technology in cardiovascular disease prevention.
Introduction:
Atrial fibrillation (AF) is a major risk factor for stroke. There is a fivefold increase in stroke risk in the presence of AF. The irregular beating of the heart enables blood stasis which allows clots to form. These can migrate to the brain causing a stroke. AF is common and its incidence increases with age. AF is often asymptomatic and early detection enables effective preventive treatment reducing stroke risk by up to two-thirds.Stroke contributes significantly to morbidity and mortality globally. In Ireland, it is the leading cause of acquired disability and second leading cause of death. The cost associated with stroke is significant. Stroke risk increases with age and is a public health priority.Internationally, there is consensus among experts that AF screening is valuable. In Ireland, the National Cardiovascular Policy recommended establishing a screening programme. However, there are many ways to screen for AF including pulse palpation, mobile ECG devices, 12-lead ECG and personal health monitoring devices.This study aims to investigate the acceptability, feasibility and impact of AF screening in primary care using a handheld mobile ECG device.
Methods And Analysis:
General practitioners (GPs) and practice nurses in the South of Ireland will opportunistically screen patients aged ≥65 years for AF at routine consultation using a handheld one-lead ECG device, KardiaMobile. This study will screen up to 4000 patients. Blood pressure and smoking status will be checked concurrently. A mixed-method evaluation will be undertaken including a partial economic evaluation. Anonymised data will be collected from participating practices and qualitative interviews will be conducted with GP, nurse and patient participants.
Ethics And Dissemination:
Ethical approval has been granted by the Clinical Research Ethics Committee in University College Cork. Dissemination will involve publication in peer-reviewed journals and presentation at national and international conferences.
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