Wilkinson, Chris orcid.org/0000-0003-0748-0150, Moloney, Susan, McClelland, Graham et al. (3 more authors) (2024) Actioning atrial fibrillation identified by ambulance services in England:a qualitative exploration. BMJ Open. e078777. ISSN 2044-6055
Abstract
OBJECTIVES: To explore the acceptability and feasibility of detection of atrial fibrillation (AF) by emergency medical services (EMS) and identify potential barriers and facilitators to implementing a formal pathway to facilitate follow-up in primary care, which could reduce the risk of AF-related stroke. DESIGN: Qualitative study using focus groups and one-to-one interviews guided by a semistructured topic guide. SETTING: North East England. PARTICIPANTS: Focus groups with 18 members of the public and one-to-one online interviews with 11 healthcare and service providers (six paramedics and five experts representing cardiology, general practice (GP), public health, research, policy and commissioning). RESULTS: All participant groups were supportive of a role of EMS in identifying AF as part of routine assessment and formalising the response to AF detection. However, this should not create delays for EMS since rate-controlled AF is non-urgent and alternative community mechanisms exist to manage it. Public participants were concerned about communication of the AF diagnosis and whether this should be 'on scene' or in a subsequent GP appointment. Paramedics reported frequent incidental identification of AF, but it is not always clear 'on scene' that this is a new diagnosis, and there is variation in practice regarding whether (and how) this is communicated to the GP. Paramedics also focused on ensuring the safety of non-conveyed patients and a perceived need for an 'active' reporting process, so that a finding of AF was actioned. Field experts felt that a formal pathway would be useful and favoured a simple intervention without adding to time pressures unnecessarily. CONCLUSIONS: There is support for the development of a formal pathway to ensure follow-up for people with AF that is incidentally detected by EMS. This has the potential to improve anticoagulation rates and reduce the risk of stroke.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2024. |
Keywords: | Humans,Atrial Fibrillation/therapy,England,Qualitative Research,Emergency Medical Services,Male,Female,Ambulances,Focus Groups,Middle Aged,Adult,Stroke/prevention & control,Aged,Interviews as Topic,Primary Health Care,Attitude of Health Personnel |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Hull York Medical School (York) |
Depositing User: | Pure (York) |
Date Deposited: | 12 Sep 2024 04:25 |
Last Modified: | 01 Apr 2025 23:11 |
Published Version: | https://doi.org/10.1136/bmjopen-2023-078777 |
Status: | Published online |
Refereed: | Yes |
Identification Number: | 10.1136/bmjopen-2023-078777 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:217141 |