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Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol

Orchard, Jessica J; Neubeck, Lis; Freedman, Ben; Webster, Ruth; Patel, Anushka; Gallagher, Robyn; Li, Jialin; Hespe, Charlotte Mary; Ferguson, Caleb; Zwar, Nicholas; Lowres, Nicole

Authors

Jessica J Orchard

Ben Freedman

Ruth Webster

Anushka Patel

Robyn Gallagher

Jialin Li

Charlotte Mary Hespe

Caleb Ferguson

Nicholas Zwar

Nicole Lowres



Abstract

Introduction: Screening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified.
This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach.
Methods and analysis: Screening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3–4 months during 2018–2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a ‘control’ dataset of practices.
Ethics and dissemination Ethics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations.
Trial registration number ACTRN12618000004268; Pre-results.

Citation

Orchard, J. J., Neubeck, L., Freedman, B., Webster, R., Patel, A., Gallagher, R., …Lowres, N. (2018). Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol. BMJ Open, 8(10), Article e023130. https://doi.org/10.1136/bmjopen-2018-023130

Journal Article Type Article
Acceptance Date Sep 26, 2018
Online Publication Date Oct 31, 2018
Publication Date 2018-10
Deposit Date Dec 3, 2018
Publicly Available Date Mar 28, 2024
Journal BMJ Open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Issue 10
Article Number e023130
DOI https://doi.org/10.1136/bmjopen-2018-023130
Keywords Screening protocol, Arterial Fibrillation, evidence-based intervention,
Public URL http://researchrepository.napier.ac.uk/Output/1344699

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0/

Copyright Statement
© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.







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