Screening Education And Recognition by primary Care pHysician of Atrial Fibrillation for prevention of stroke (SEARCH-AF II)

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Atrial fibrillation (AF) is the most common heart arrhythmia affecting at least 240,000 Australians. Prevalence rises with age from approximately 1% of the whole population to 5% in those over 65 years. People with AF are up to seven times more likely to have a stroke than the general population, and AF related strokes are also likely to be more severe. In addition, one in every six strokes is AF related. Stroke is highly preventable in AF with the use of appropriate thromboprophylaxis. Therefore early identification and appropriate evidence based management of AF could lead to subsequent stroke prevention, significant reduction in the overall stroke burden and substantial savings to the health system. The study is designed to examine the feasibility of screening to identify undiagnosed AF in a primary care setting. Our hypothesis is that a simple primary care screening program may be effective in detecting those with undiagnosed AF. The specific aims are to: 1. Assess the feasibility and acceptability of screening for AF using a hand-held single-lead ECG device in people aged 65 years and over in the general practice setting. 2. Assess the satisfaction of GPs, reception staff and patients with the screening process in the general practice setting. 3. Examine process measures, such as the time taken to complete the intervention, competing demands for practice reception staff time, and the attitudes of patients and staff involved in the intervention. 4. Identify barriers (including technological barriers), enablers and other information relevant to the process of developing a larger-scale implementation study. We propose a cross-sectional study offered in up to 5 general practices in the Sydney metropolitan area. People aged 65 and over, attending general practices will be invited to volunteer for the screening. The screening will consist of an assessment with a handheld single-lead ECG device attached to an iPhone by the practice receptionist. This ECG will be transmitted to a secure website and reviewed by the patient's GP during their consultation. The primary outcome measure will be the acceptability of the screening process. A process evaluation will also be undertaken to better appreciate factors that might influence sustainability beyond the trial setting.

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