Actioning atrial fibrillation identified by ambulance services in England: a qualitative exploration

TY - JOUR

T1 - Actioning atrial fibrillation identified by ambulance services in England

T2 - a qualitative exploration

AU - Wilkinson, Chris

AU - Moloney, Susan

AU - McClelland, Graham

AU - Todd, Adam

AU - Doran, Tim

AU - Price, Christopher

N1 - © Author(s) (or their employer(s)) 2024.

PY - 2024/9/5

Y1 - 2024/9/5

N2 - OBJECTIVES: To explore the acceptability and feasibility of detection of atrial fibrillation (AF) by emergency medical services (EMS) and identify potential barriers and facilitators to implementing a formal pathway to facilitate follow-up in primary care, which could reduce the risk of AF-related stroke.DESIGN: Qualitative study using focus groups and one-to-one interviews guided by a semistructured topic guide.SETTING: North East England.PARTICIPANTS: Focus groups with 18 members of the public and one-to-one online interviews with 11 healthcare and service providers (six paramedics and five experts representing cardiology, general practice (GP), public health, research, policy and commissioning).RESULTS: All participant groups were supportive of a role of EMS in identifying AF as part of routine assessment and formalising the response to AF detection. However, this should not create delays for EMS since rate-controlled AF is non-urgent and alternative community mechanisms exist to manage it. Public participants were concerned about communication of the AF diagnosis and whether this should be 'on scene' or in a subsequent GP appointment. Paramedics reported frequent incidental identification of AF, but it is not always clear 'on scene' that this is a new diagnosis, and there is variation in practice regarding whether (and how) this is communicated to the GP. Paramedics also focused on ensuring the safety of non-conveyed patients and a perceived need for an 'active' reporting process, so that a finding of AF was actioned. Field experts felt that a formal pathway would be useful and favoured a simple intervention without adding to time pressures unnecessarily.CONCLUSIONS: There is support for the development of a formal pathway to ensure follow-up for people with AF that is incidentally detected by EMS. This has the potential to improve anticoagulation rates and reduce the risk of stroke.

AB - OBJECTIVES: To explore the acceptability and feasibility of detection of atrial fibrillation (AF) by emergency medical services (EMS) and identify potential barriers and facilitators to implementing a formal pathway to facilitate follow-up in primary care, which could reduce the risk of AF-related stroke.DESIGN: Qualitative study using focus groups and one-to-one interviews guided by a semistructured topic guide.SETTING: North East England.PARTICIPANTS: Focus groups with 18 members of the public and one-to-one online interviews with 11 healthcare and service providers (six paramedics and five experts representing cardiology, general practice (GP), public health, research, policy and commissioning).RESULTS: All participant groups were supportive of a role of EMS in identifying AF as part of routine assessment and formalising the response to AF detection. However, this should not create delays for EMS since rate-controlled AF is non-urgent and alternative community mechanisms exist to manage it. Public participants were concerned about communication of the AF diagnosis and whether this should be 'on scene' or in a subsequent GP appointment. Paramedics reported frequent incidental identification of AF, but it is not always clear 'on scene' that this is a new diagnosis, and there is variation in practice regarding whether (and how) this is communicated to the GP. Paramedics also focused on ensuring the safety of non-conveyed patients and a perceived need for an 'active' reporting process, so that a finding of AF was actioned. Field experts felt that a formal pathway would be useful and favoured a simple intervention without adding to time pressures unnecessarily.CONCLUSIONS: There is support for the development of a formal pathway to ensure follow-up for people with AF that is incidentally detected by EMS. This has the potential to improve anticoagulation rates and reduce the risk of stroke.

KW - Humans

KW - Atrial Fibrillation/therapy

KW - England

KW - Qualitative Research

KW - Emergency Medical Services

KW - Male

KW - Female

KW - Ambulances

KW - Focus Groups

KW - Middle Aged

KW - Adult

KW - Stroke/prevention & control

KW - Aged

KW - Interviews as Topic

KW - Primary Health Care

KW - Attitude of Health Personnel

U2 - 10.1136/bmjopen-2023-078777

DO - 10.1136/bmjopen-2023-078777

M3 - Article

C2 - 39237274

SN - 2044-6055

VL - 14

JO - BMJ Open

JF - BMJ Open

IS - 9

M1 - e078777

ER -