People who decided to take part in screening for atrial fibrillation, a common heart condition, believed strongly in the benefits of screening, according to new research.
The in-depth study of 23 participants in the SAFER trial of screening for atrial fibrillation (AF) looks at why these participants opted in and provides insight into their understanding of the AF screening they were undertaking.
University of Cambridge researchers from the SAFER trial conducted this study, which is published in BMJ Open. The team carried out 53 interviews with 23 SAFER participants throughout their screening experience. The screening involved using a Zenicor hand-held single-lead ECG device four times a day for between one and four weeks.
Overall, participants described screening as a routine obligation and something one ‘ought’ to do as a responsible patient to ensure good health and prevent illness. Screening invitations were typically seen as legitimate requests from a clinical authority which was presumed to recommend the screening programme. Most people in the study thought screening was a safe way to facilitate earlier diagnosis, more effective treatment and a better future outcome.
Though participants in this study had little knowledge of AF before being invited to join the SAFER trial and most did not expect to receive a diagnosis of AF after being screened, the association of AF with stroke made AF screening seem particularly worthwhile.
One participant explained: “I would try to do everything I can not to have a stroke. […] As far as I’m concerned, it’s a no-brainer. Once you’ve had the stroke, whatever life you have got left, it’s not going to be much fun, so try and avoid it.”
The AF screening test involves participants placing their thumbs or two fingers on a portable ECG device. Participants thought that this was a harmless way to see if they unknowingly had the condition and therefore to reduce their risk of stroke, often comparing it with the ease with which blood pressure measurements are taken. Participants rarely recognised any other ‘iatrogenic’, or medically-induced, risks that might be linked with the screening, like false positives leading to unnecessary treatment. One said: “Any harm? No I don’t think that any harm can arise from that all, personally, screening, no.”
Clinicians offering AF screening should be prepared to work with patients to help them understand what they are being offered. Counselling patients on the benefits and risks of AF screening is important, while we await clinical evidence on managing screen-detected AF from the ongoing SAFER trial.”
– Dr Sarah Hoare, lead author, SAFER team, University of Cambridge
Dr Hoare said, “Participants in this study knew they were taking part in research about screening, and many took part to ‘help out’. Nevertheless, our research suggests that in AF screening you might expect to find that participants are unfamiliar with AF. We would also expect participants to think that screening is recommended and perhaps assume that an AF test is a comprehensive heart function review that leads to curative treatment (which it isn’t).”
The SAFER study is funded by NIHR.
Read this research
S Hoare, A Powell, R Modi, N Armstrong, S Griffin, J Mant and The SAFER Authorship Group: Why do people take part in atrial fibrillation screening? Qualitative interview study. BMJ Open.
See more about the SAFER trial
Queries: please contact Lucy Lloyd
Image: the AF monitoring device from Zenicor