Atrial fibrillation (AF) is a condition in which the heart beats irregularly. It is present in approximately 10% of people aged over 65 and increases the risk of stroke five-fold, as well as being associated with other negative health outcomes. Approximately 30% of strokes are associated with AF but 10% of strokes occur in people unaware that they have AF because it is often asymptomatic and undiagnosed. With acceptable and accessible technology to detect AF and oral anticoagulants to reduce the risk of stroke, there is a credible argument for systematic screening for AF in older people. However, national and international screening decision-makers have not yet endorsed AF screening because it is not known whether AF screening followed by anticoagulation of those found to have AF will significantly reduce strokes and other negative health outcomes, whether it does not significantly increase harms, and whether this is cost-effective. In addition, there is a call for evidence on how best to implement an AF screening programme.

The SAFER (Screening for Atrial Fibrillation with ECG to Reduce stroke) trial is a cluster randomised controlled trial (RCT) of screening for AF in people aged over 70 using a hand-held ECG device, to determine whether this reduces stroke and improves other key outcomes compared to usual practice over an average follow up of five years, and whether this is cost-effective. The work in this PhD forms part of the process evaluation of the SAFER trial and, in particular, will examine how central management and general practices might best deliver AF screening. This is in order to provide recommendations for the replication and scaling to a national-level programme.

To describe and evaluate the delivery of screening for atrial fibrillation within the SAFER trial, to inform recommendations for the replication and scaling of screening for atrial fibrillation.

Objectives

• To conduct a systematic review to describe and critically evaluate the delivery of screening programmes in primary and community care.
• To undertake a multi-method process evaluation to explore the delivery of screening for atrial fibrillation within the SAFER trial from the perspectives of general practice and the central trial management team.
• To combine these findings with a logic model to produce a theory of atrial fibrillation screening as performed in the SAFER trial and generate recommendations for the replication and scaling of atrial fibrillation screening.