Key stakeholder views on atrial fibrillation screening: a systematic mixed-studies review and interpretive analysis

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Understanding barriers and stakeholder needs is crucial for designing effective atrial fibrillation (AF) screening programs.
• Existing literature on AF screening implementation lacks comprehensive stakeholder perspectives, particularly from system-level decision-makers.

Purpose of the Study:

• To synthesize existing literature on stakeholder needs and implementation barriers for atrial fibrillation (AF) screening.
• To identify key concepts and requirements for successful AF screening program design and implementation.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Web of Science) and grey literature.
• Included studies focused on stakeholder views regarding AF screening implementation.
• A critical interpretive synthesis approach was used to analyze the data from 34 included papers.

Main Results:

• Stakeholders expressed cautious optimism regarding AF screening benefits and enhanced practice roles, but raised concerns about risks, patient burden, and healthcare system strain.
• Risk-based screening models and handheld ECG devices were favored over systematic or direct-to-consumer approaches.
• Key implementation barriers included time constraints, workflow disruption, inadequate remuneration, data system issues, and a need for clear guidelines and inter-agency collaboration.

Conclusions:

• Atrial fibrillation (AF) screening is acceptable, but definitive evidence on its necessity and potential harms is needed.
• Successful implementation requires cross-sector collaboration, equitable access, clear pathways, and robust data security solutions.
• Further research should focus on system-level barriers, decision-maker perspectives, and strategies for addressing jurisdictional-specific challenges.