Evaluation of key stakeholder views on implementation of atrial fibrillation screening in Australia: a qualitative study

Background Opportunistic atrial fibrillation (AF) screening is recommended in AF management guidelines, but it is not routinely implemented. Purpose To understand the issues impacting AF screening, and what needs to be considered for a successful Australian national AF screening program. Methods Ten broad stakeholder groups were identified including charities, patient support, healthcare professionals, professional bodies, public health, government, research, health insurance, pharmacy and industry. Semi-structured interviews were conducted with 25 representative participants. We used iterative thematic analysis. Coding was driven by the research questions (the current context; is a national screening program warranted; and approaches to a national screening program) and an inductive approach where novel groupings of information were identified. Results The key findings are grouped into four areas. 1) Current opportunistic GP-led screening is ad hoc and fragmented. Issues: poor remuneration; lack of health sector collaboration and prioritisation; and consumers lack awareness. 2) Systematic screening of ALL in-scope patients not considered feasible, especially due to health system variation across the country; and concerns over lack of evidence. 3) Alternative approaches to increase screening include innovative approaches inside and outside general practice and use of smart technology. 4) Recommendations: i. Support general practices and address remuneration and workflows; ii. Ensure a clear pathway to treatment; iii. Address data security, management and integration; and sensitivity issues with wearable devices; iv. Promote collaboration between key organisations; v. Address research gaps; vi. Generate culturally appropriate consumer education to promote consumer demand. Conclusions Most stakeholders were supportive of the need to screen and agreed that current approaches were not sufficient. Once evidence gaps are addressed and if they support screening, stakeholders envisaged a semi-systematic approach to increase opportunistic screening, rather than a systematic national screening program. Figure 1: Results Model.Results model