GPs rank routine screening for AF as crucial as for common cancers

Screening for atrial fibrillation (AF) is considered to be as important as for common cancers and should be incorporated into other healthcare programmes such as flu vaccination and cancer screening programmes, based on data from the AFFECT-EU survey of GPs that was presented at EHRA 2022.

“The ESC* recommends opportunistic screening for AF by pulse taking or electrocardiogram (ECG) rhythm strip in patients ≥65 years,” said presenting author Paulien Vermunicht, a doctoral candidate at the University of Antwerp in Antwerp, Belgium.

“However, there is no clear guidance on how to implement AF screening in daily clinical practice,” she noted.

Based on 561 responses collected from GPs across Europe, participants rated the need for standardised AF screening as 83.2 on a scale ranging from 0 to 100 — a high rating which was close to those for colon, breast, and cervical cancers (rated 86.5, 86.8, 89.2, respectively).

Despite the high perceived need, very few AF screening programmes were established in Europe, with 87 percent of GPs reported that there were no AF screening programmes in their region. By comparison, screening programmes for colon, breast and cervical cancers were in place in 70.1 percent, 80.9 percent, and 87.3 percent of the GP’s practice, respectively.

In terms of feasibility, only one out of eight GPs (12.8 percent) reported having a single lead ECG device in their clinics. On the other hand, a 12-lead ECG device was rather common and were present in approximately three out of four GPs practice (72.7 percent).

Also, three in five GPs (60.4 percent) reported feeling confident in ruling out AF using a 30-second single lead ECG rhythm strip.

One in four GPs (25.3 percent) believed they would have no barriers and can readily start performing AF screening.

Almost one in five GPs (18.9 percent) indicated that they required more education before starting AF screening and 18.7 percent reported that they lacked resources (such as ECG qualification or trained personnel) for implementing AF screening in their practice.

Few GPs (10.5 percent) were concerned about false positives during screening that might cause patient to be anxious.

Possible solutions to overcome these barriers to AF screening, as reported by 24.3 percent of GPs, included integration of AF screening into other common existing programmes such as flu vaccination or cancer screening programmes. Another suggestion, indicated by 24.2 percent of the respondents, was to integrate a software algorithm into the primary care system that helps identify patients (based on age and/or medical history) who may be candidates for AF screening. 

“The AFFECT-EU consortium has created an algorithm that identifies patients at risk of AF based on the information in their medical record,” said project coordinator Professor Renate Schnabel from the University Medical Centre Hamburg-Eppendorf in Hamburg, Germany.

“When the patient visits the practice for any reason, the primary care software system alerts GPs who can then perform ECG screening. This procedure is being tested in Germany and is a big step forward,” she explained.

Approximately one-third of GPs (31.2 percent) believed that additional education about ECG in general would help them gain more confidence in starting AF screening. In addition, having a standardized follow-up pathway with a fast-tracked referral to cardiologist when necessary was considered to be of added value by 25.7 percent of the respondents.  

*ESC: European Society of Cardiology