Pathways to diagnosis of atrial fibrillation: findings from a qualitative study in primary care

Background Atrial fibrillation (AF) is underdiagnosed and approximately 10% of ischemic strokes occur in people with unrecognised AF.

Aim To explore the patient path to diagnosis of AF and identify ways to improve detection

Design & setting Qualitative study in UK primary care

Method We interviewed patients with a recent diagnosis of AF (<6 months) to understand their path to diagnosis, and primary care clinicians to explore their experience of detecting AF. The data were analysed using framework analysis.

Results Thirty patients and ten primary care clinicians were interviewed. Patients with non-specific symptoms generally did not perceive the symptoms as serious, and many delayed seeing a healthcare professional. Their experiences in primary care aligned with findings from interviews with primary care clinicians, who acknowledged AF may not necessarily be the initial suspicion when a patient presents with certain non-specific symptoms. Primary care clinicians described narratives of good practice in the form of opportunistic pulse palpation, and challenges of detecting AF in primary care such as lack of access to holter tests and limited opportunities to detect AF due to remote consultations and healthcare assistants taking on more responsibilities.

Conclusions Our findings suggest that increased public awareness of AF could improve symptom appraisal and help-seeking from healthcare professionals. Recommending opportunistic pulse palpation in primary care is also indicated. Access to holter tests and other devices in primary care may help reduce delays in diagnosis.