eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline-Recommended Therapy in Metropolitan General Practice: The AF - SMART Study

J Am Heart Assoc. 2019 Jan 8;8(1):e010959. doi: 10.1161/JAHA.118.010959.


Background This eH ealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation ( AF ) screening using electronic screening prompts and improve treatment using electronic decision support ( EDS ) software. Methods and Results An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline-based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years; mean CHA 2 DS 2- VAS c, 3.7; 53% men). General practitioners (n=30) performed 70% of all screenings (range 1-448 patients per general practitioner). The proportion of patients with AF who had CHA 2 DS 2- VAS c ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen-detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study ( P<0.001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen-detected patients. Conclusions The eH ealth tools showed promise. Adherence to guideline-based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. Clinical Trial Registration URL : . Unique identifier: ACTRN 12616000850471.

Keywords: atrial fibrillation; eHealth; general practices; screening; stroke prevention.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Aged
  • Algorithms*
  • Anticoagulants / administration & dosage
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / drug therapy
  • Atrial Fibrillation / epidemiology
  • Australia / epidemiology
  • Disease Management*
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • General Practice / statistics & numerical data*
  • Guideline Adherence*
  • Humans
  • Male
  • Mass Screening / methods*
  • Morbidity / trends
  • Retrospective Studies
  • Smartphone
  • Telemedicine / methods*
  • Time Factors


  • Anticoagulants

Associated data

  • ANZCTR/ACTRN12616000850471