Opportunistic detection of atrial fibrillation using the Mydiagnostick: a mixed methods evaluation.

Problem

Atrial fibrillation (AF) is a cardiac arrhythmia which significantly increases the risk of ischemic stroke. Strokes associated with AF have more debilitating consequences. Many people with AF are asymptomatic and remainundiagnosed. Opportunistic screening in UK General Practices is recommended due to it’s cost effectiveness compared to mass screening and better than usual care in detecting AF. National guidance recommends pulse checks for AF during routine patient contact, but this is often not performed. Non-invasive devices like the Mydiagnostick could improve early detection of AF. The Mydiagnostick registers and spontaneously analyses the single-lead I rhythm strip. We evaluated the introduction of opportunistic AF detection using a handheld device (MyDiagnostick) in primary care.

Approach

Devices and access to manufacturers’ training and information were provided to pharmacist, nurses, health care assistants in 6 general practices 1 pharmacy and 20 care homes served by one community nursing team in North West England. Eligible patients were: aged 65 or over; did not have an existing AF diagnosis and not receiving end-of-life care; residents of care home; attending either a community pharmacy or a GP practice for practice nurse or HCA clinic. Uptake and outcomes of MyDiagnostick testing were monitored for three months. Patient acceptability was evaluated using self-completed short feedback questionnaires with forced-choice responses relating to ease of use and understanding of test. Staff views were evaluated using semi-structured qualitative interviews based on Normalisation Process Theory. Study used purposive sampling which included different grades of staff across all the study sites.

Findings

To date, 5 sites have completed the pilot with 545 patients offered the test for AF. Further data from two sites including a pharmacy and 1 GP practice will be available. 27/515 people (5.3%) had a positive result, requiring further assessment. Patients’ views were overwhelmingly positive; suggested improvements included having more time to decide about the test and a clearer explanation of results. To date, interviews have been conducted with 15 staff, 2 group interviews and 10 individual ones. Preliminary findings suggest that although the opportunity to detect and treat AF was valued, challenges such as technical problems, documentation and referral, staff training and coordination, management of workload needed to be overcome.

Consequences

The introduction of medical devices to facilitate opportunistic detection of AF in primary care is well-received by both patients and staff, but needs planning and support to enable staff to incorporate the tests into routine practice and to provide appropriate information and support to patients.