Screening for atrial fibrillation (AF) should be integrated into flu vaccination and cancer screening programmes, according to a survey of general practitioners (GPs) conducted by the AFFECT-EU project and presented at the 2022 European Heart Rhythm Association annual meeting (EHRA 2022, 3‒5 April, Copenhagen, Denmark).
“Our study indicates that few atrial fibrillation screening programmes are established in Europe, yet GPs strongly believe they are needed,” said study author Paulien Vermunicht, a doctoral student at the University of Antwerp (Antwerp, Belgium).
AFFECT-EU is an EU funded project to define the optimal screening strategy for AF with the ultimate aim of preventing subsequent strokes and premature death. The project previously reported that opportunistic screening in primary care with single lead electrocardiogram (ECG) devices was considered the most feasible approach by healthcare professionals and regulators.
Screening in this way is performed when a patient attends the practice for any reason. The patient’s heart rhythm is assessed using a single lead ECG which is generally a compact, handheld device that is quick and simple to use. GPs in Europe were asked their opinions of implementing this screening approach in daily clinical practice and the results are presented today.
A multiple choice survey was emailed to GP contacts of AFFECT-EU consortium members and GP organisations. There were four sections: 1) general characteristics of the participants (e.g. location); 2) current practice and perceptions of screening for different diseases; 3) feasibility of opportunistic single lead ECG screening; 4) barriers to implementing this type of screening and preferred solutions.
A total of 561 responses were collected (37.1% Eastern, 29.4% Central, 12.1% Southern, 11.1% Northern, 9.4% Western Europe and 0.9% outside Europe). Regarding current practice, 87% of GPs indicated that no AF screening is established in their region, while 70.1%, 80.9% and 87.3% said programmes were in place for colon, breast and cervical cancers, respectively. However, the need for standardised AF screening was rated as 82.3 on a scale from 0 to 100, which was almost as high as for colon (86.5), breast (86.8) and cervical (89.2) cancers.
As for feasibility, just 12.8% of GPs had a single lead ECG device in their practice. Nevertheless, three in five (60.4%) said they would feel confident in ruling out atrial fibrillation on a 30-second single lead ECG rhythm strip.
One in four (25.3%) GPs reported no obstacles to starting AF screening. However, nearly one in five (18.9%) said they needed more education before commencing. Almost one in five (18.7%) stated that there were insufficient resources to implement a programme in their practice including personnel and an ECG qualification. Just over one in ten (10.5%) were concerned about detecting false positives (i.e. erroneously diagnosing atrial fibrillation) that could lead to anxiety or harm for the patient.
One of the main solutions, selected by 24.3% of GPs, was to integrate AF screening into existing flu vaccination or cancer screening programmes. The second most popular idea, selected by 24.2% of respondents, was to incorporate an algorithm into primary care software systems to identify patients suitable for atrial fibrillation screening based on their age and/or medical history.
Project coordinator Renate Schnabel of the University Medical Centre Hamburg-Eppendorf, (Hamburg, Germany), said: “The AFFECT-EU consortium has created an algorithm that identifies patients at risk of atrial fibrillation based on the information in their medical record. When the patient visits the practice for any reason, the primary care software system alerts GPs who can then perform ECG screening. This procedure is being tested in Germany and is a big step forward.”