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

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

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Article numbere023130
JournalBMJ Open
Volume8
Issue number10
DOIs
Publication statusPublished - 31 Oct 2018
Externally publishedYes

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Atrial Fibrillation
Primary Health Care
Guidelines
General Practice
Anticoagulants
Therapeutics
Stroke
Clinical Audit
South Australia
New South Wales
Workflow
Research Ethics Committees
Ethics
General Practitioners
Cost-Benefit Analysis
Publications
Cardiac Arrhythmias
Electrocardiography
Nurses
Interviews

Cite this

Orchard, Jessica J. ; Neubeck, Lis ; Freedman, Ben ; Webster, Ruth ; Patel, Anushka ; Gallagher, Robyn ; Li, Jialin ; Hespe, Charlotte Mary ; Ferguson, Caleb ; Zwar, Nicholas ; Lowres, Nicole. / Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting : an implementation study protocol. In: BMJ Open. 2018 ; Vol. 8, No. 10.
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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.",
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Orchard, JJ, Neubeck, L, Freedman, B, Webster, R, Patel, A, Gallagher, R, Li, J, Hespe, CM, Ferguson, C, Zwar, N & 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, vol. 8, no. 10, e023130. https://doi.org/10.1136/bmjopen-2018-023130

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.

In: BMJ Open, Vol. 8, No. 10, e023130, 31.10.2018.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting

T2 - an implementation study protocol

AU - Orchard, Jessica J.

AU - Neubeck, Lis

AU - Freedman, Ben

AU - Webster, Ruth

AU - Patel, Anushka

AU - Gallagher, Robyn

AU - Li, Jialin

AU - Hespe, Charlotte Mary

AU - Ferguson, Caleb

AU - Zwar, Nicholas

AU - Lowres, Nicole

PY - 2018/10/31

Y1 - 2018/10/31

N2 - 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.

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DO - 10.1136/bmjopen-2018-023130

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