Increasing screening for atrial fibrillation in general practice: the Atrial Fibrillation Self‐Screening, Management And guideline‐Recommended Therapy (AF Self‐SMART) study

Objective To assess whether atrial fibrillation (AF) self‐screening stations in general practice waiting rooms improve AF screening, diagnosis, and stroke risk management. Design, setting Intervention study (planned duration: twelve weeks) in six New South Wales general practices (two in rural locations, four in greater metropolitan Sydney), undertaken during 28 August 2020 – 5 August 2021. Participants People aged 65 years or more who had not previously been diagnosed with AF, and had appointments for face‐to‐face GP consultations. People with valvular AF were excluded. Intervention AF self‐screening station and software, integrated with practice electronic medical record programs, that identified and invited participation by eligible patients, and exported single‐lead electrocardiograms and automated evaluations to patients’ medical records. Main outcome measures Screening rate; incidence of newly diagnosed AF during intervention and pre‐intervention periods; prescribing of guideline‐recommended anticoagulant medications. Results Across the six participating practices, 2835 of 7849 eligible patients (36.1%) had face‐to‐face GP appointments during the intervention period, of whom 1127 completed AF self‐screening (39.8%; range by practice: 12–74%). AF was diagnosed in 49 screened patients (4.3%), 44 of whom (90%) had CHA2DS2‐VA scores of 2 or more (high stroke risk). The incidence of newly diagnosed AF during the pre‐intervention period was 11 cases per 1000 eligible patients; during the intervention period, it was 22 per 1000 eligible patients (screen‐detected: 17 per 1000 eligible patients; otherwise detected: 4.6 per 1000 eligible patients). Prescribing of oral anticoagulation therapy for people newly diagnosed with AF and high stroke risk was similar during the pre‐intervention (20 of 24, 83%) and intervention periods (46 of 54, 85%). Conclusions AF self‐screening in general practice waiting rooms is a feasible approach to increasing AF screening and diagnosis rates by reducing time barriers to screening by GPs. AF self‐screening could reduce the number of AF‐related strokes. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000233921 (prospective).