Key Stakeholder views on atrial fibrillation screening: a systematic mixed-studies review and interpretive analysis.

BACKGROUND AND AIMS: It is essential to understand the key barriers and stakeholder needs related to screening to focus efforts for designing appropriate programs. Therefore, this study aimed to synthesise the existing literature to understand the pertinent concepts and requirements from key stakeholders regarding implementation of atrial fibrillation (AF) screening. METHODS: Database searches were run in MEDLINE via Ovid, Embase via Ovid, CINAHL via Ebsco, PsycInfo via Ebsco, Scopus, and Web of Science Core Collection using specified keywords; supplemented by Google and grey literature searches. Original research papers were included if they contained stakeholder views on implementation of AF screening. A critical interpretive synthesis of data was performed. RESULTS: From 13,332 titles/abstracts, 105 full texts were reviewed, and 34 papers included (16 qualitative; 8 surveys; 10 mixed-methods). Significant evidence gaps were identified related to systematic and population-wide screening programs; and views from system-level stakeholders/key decision-makers. The key themes were: 1) VALUE, BENEFITS AND RISKS OF SCREENING: Stakeholders were cautiously optimistic, liked enhanced practice roles; and positive about health benefits. Concerns raised about potential risks/harms (e.g. anticoagulation), worry for patients, and increased burden for the practice/healthcare system. 2) PERSPECTIVES ON APPROPRIATE MODELS: Systematic screening not supported by evidence; risk-based approaches suggested; handheld ECG perceived as quick and easy-to-use; concerns raised over direct-to-consumer devices. 3) FACTORS IMPACTING IMPLEMENTATION WITHIN HEALTHCARE SETTINGS: Time constraints, impact on workflow, remuneration/reimbursement, and data systems and data security problems were the most common barriers. 4) SYSTEMIC BARRIERS: These included the need for evidence of benefit; clear guidelines and pathways; adequate remuneration/reimbursement; importance of inter-agency collaboration; software; and access and inclusivity for all patients. CONCLUSION: AF screening is acceptable however definitive evidence regarding need and harms is required. Implementation will require collaboration across healthcare sectors; local solutions; equitable access; remuneration/reimbursement; defined responsibilities and clear pathways; consideration of integration of complex systems; and data security solutions. Given the central importance of system level barriers, more research is needed on the perspectives and needs of system-level stakeholders, key decision-makers and consumer groups. Additionally, further research is required to identify strategies for how to address barriers in specific health care jurisdictions.