Why do people take part in atrial fibrillation screening? A longitudinal interview study with SAFER trial participants

Problem

A number of patient groups, charities and clinical organisations have championed the practice of case finding for atrial fibrillation (AF), arguing that early AF diagnosis and treatment may reduce the incidence of stroke. Calls for increased AF case-finding are ranged against concerns about the potential proliferation of unregulated ‘back-door’ screening; the UK National Screening Committee currently states there is insufficient evidence to support a national AF screening programme. Within this debate the attitude of the public towards AF screening is unknown. The aim of this study was to explore the reasons why participants chose to engage in an AF screening trial.

Approach

We conducted semi-structured longitudinal interviews with participants in the feasibility phase of the SAFER trial (Screening for Atrial Fibrillation with ECG to Reduce stroke). Interview participants were sampled purposively in relation to age and gender. Initial face-to-face interviews took place shortly after participants accepted an invitation to take part in SAFER; up to two follow-up interviews took place via telephone, spaced throughout and following the four-week screening process. We used a flexible topic guide to explore experiences of and attitudes towards screening and AF screening. Interviews were analysed thematically, using both inductive and deductive codes. Themes were synthesised to understand shared views of screening participation, aided by reference to the social science screening literature.

Findings

We interviewed 24 participants, totalling 55 interviews (interview 1 n=24, interview 2 n=10, interview 3 n=21). Participants were highly supportive of the AF screening programme, underpinned by the belief that screening was a ‘good thing to do’. Whilst AF was unfamiliar to most without personal experience of the condition, stroke was well-known and frightening. For participants, AF screening functioned as a way of attenuating the perceived risk and anxiety of having a stroke, but also more broadly to demonstrate (both to themselves and others) their commitment to self-care and being a ‘good patient’. Should they be diagnosed with AF, this would offer beneficial early diagnosis and treatment, and further contribute to the maintenance of their health. However, importantly, participants were unlikely to consider themselves to be candidates for AF on entering the screening programme. Engaging in AF screening was therefore thought to be relatively low risk, especially as the screening test was seen as non-invasive. Further, AF screening was commonly presumed to offer a wider health check beyond an assessment of cardiac arrhythmias.

Consequences

Participants in AF screening can have wider aspirations for the programme than the identification of AF, and the communication of screening results needs to manage expectations effectively. Negative AF screening results may lead to false reassurance concerning wider cardiac risks.