Abstract
INTRODUCTION: Atrial fibrillation (AF) is a condition associated with increased risk of stroke. The risk of stroke can be reduced by oral anticoagulation (OAC) medication, but as AF is often asymptomatic, it can go unrecognised. Given the move away from face-to-face consultations, it is important to take advantage of any opportunities for AF detection and onward evaluation for potential OAC prescription. Emergency medical services (EMS) provide face-to-face assessments that can provide the oppportunity to identify incidental AF. However, little is known about how EMS manage patients with incidental detection of AF or what the optimum approach may be. The aim of this service evaluation was therefore to describe current practice within UK EMS for the detection of and response to incidental AF.
METHODS: Interview-delivered surveys were conducted by the lead researcher between June and August 2023 with participants from the large UK ambulance trusts. Participants were emailed directly to ask if they would agree to be interviewed. All interviews were conducted via Microsoft Teams. The survey was developed by the co-authors, refined during the project and included all aspects of the patient pathway. Content analysis was used by the lead researcher to analyse the interviews.
RESULTS: There were variations in clinical aspects, such as pulse palpation, and only five trusts had a clear process about managing incidental findings. Methods for information sharing with primary care varied between in- and out-of-hours periods, according to the services that were available locally, leading to heterogeneity of care.
CONCLUSION: An EMS encounter can provide an opportunity to identify incidental AF and instigate ongoing care for modification of stroke risk; however, there is variability in practice across the UK. To ensure that opportunities for stroke risk reduction are maximised, a robust mechanism for clinical information sharing with primary care regarding incidental AF is required.