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

PLoS One. 2016 Apr 1;11(4):e0152086. doi: 10.1371/journal.pone.0152086. eCollection 2016.

Abstract

Introduction: Screening 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.

Methods: A 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.

Results: At 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.

Conclusion: Inner-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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / epidemiology
  • Attitude of Health Personnel
  • Cities / epidemiology
  • Cross-Sectional Studies
  • Education, Nursing
  • Electrocardiography
  • General Practice* / education
  • General Practitioners* / education
  • Humans
  • Mass Screening
  • Nurses
  • Primary Health Care
  • United Kingdom / epidemiology

Grant support

The study was supported by an NIHR/School for Primary Care Research GP Career Progression Fellowship (RC08E7) and Research Capability Funding from Nottingham City Clinical Commissioning Group (PCT/UoN/01/RCF/12-13). Tim Coleman acknowledges support from East Midlands CLAHRC. The funding bodies had no role in the design, conduct, interpretation and writing of the report for this research. Views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institute for Health Research (NIHR) or Nottingham City Clinical Commissioning Group (CCG).