Atrial Fibrillation Screening in the Community: An Integrated Continual Care Approach

Abstract

Introduction: Atrial fibrillation (AF) screening enables early diagnosis, allowing patients to manage risk factors for stroke, heart failure, and dementia. Integrated continual care refers to a structured approach for screening AF within the community, enabling seamless access to necessary health services for patients and general practitioners (GPs).

Methods: I reviewed global AF screening studies, conducted a usability study of a handheld 12-lead ECG device, a systematic review and meta-analysis of handheld ECG accuracy, and a randomised control trial (RCT) where adults aged 75+ self-screened using single-lead ECGs, with process evaluations identifying enablers and barriers using Critical Realism and Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis.

Results: The review revealed increasing AF screening with handheld ECG devices globally. In the case study, clinicians took an average of 3.1 minutes to acquire a 12-lead ECG, including setup time, and user feedback showed that 12-lead ECGs were challenging in busy clinics. Meta-analysis of 14 studies showed handheld single-lead ECGs had 89% sensitivity (95% CI 81% to 94%) and 99% specificity (95% CI 98% to 99%). In the RCT, 98.5% adherence over six months yielded 31,980 ECGs, diagnosing AF in 10.3% compared to 2.0% in usual GP care, and needed to screen 12 participants to find one additional AF. Most AF cases (80%) were diagnosed in the first three months of the intervention. Process evaluation identified the credibility of the screening team, training, support, and communication as enablers and technical challenges as barriers.

Conclusions: This thesis shows that integrated continual care for AF screening is feasible, effective, and scalable. It supports continual care via remote self-screening and centralised ECG review and support system. This model interfaces well with existing healthcare systems, offering adaptable methodologies that promote continual care through digital health innovations.