Hull York Medical School, University of York, York, UK
Academic Cardiovascular Unit, South Tees NHS Foundation Trust, Middlesbrough, UK.
BMJ Open. 2024 Sep 5;14(9):e078777. doi: 10.1136/bmjopen-2023-078777.
To explore the acceptability and feasibility of detection of atrial fibrillation (AF) by emergency medical services (EMS) and identify potential barriers and facilitators to implementing a formal pathway to facilitate follow-up in primary care, which could reduce the risk of AF-related stroke.
Qualitative study using focus groups and one-to-one interviews guided by a semistructured topic guide.
North East England.
Focus groups with 18 members of the public and one-to-one online interviews with 11 healthcare and service providers (six paramedics and five experts representing cardiology, general practice (GP), public health, research, policy and commissioning).
All participant groups were supportive of a role of EMS in identifying AF as part of routine assessment and formalising the response to AF detection. However, this should not create delays for EMS since rate-controlled AF is non-urgent and alternative community mechanisms exist to manage it. Public participants were concerned about communication of the AF diagnosis and whether this should be 'on scene' or in a subsequent GP appointment. Paramedics reported frequent incidental identification of AF, but it is not always clear 'on scene' that this is a new diagnosis, and there is variation in practice regarding whether (and how) this is communicated to the GP. Paramedics also focused on ensuring the safety of non-conveyed patients and a perceived need for an 'active' reporting process, so that a finding of AF was actioned. Field experts felt that a formal pathway would be useful and favoured a simple intervention without adding to time pressures unnecessarily.
There is support for the development of a formal pathway to ensure follow-up for people with AF that is incidentally detected by EMS. This has the potential to improve anticoagulation rates and reduce the risk of stroke.
探索由紧急医疗服务（EMS）检测心房颤动（AF）的可接受性和可行性，并确定在初级保健中实施促进后续治疗的正式途径的潜在障碍和促进因素，从而降低 AF 相关中风的风险。
使用焦点小组和半结构化主题指南指导的一对一访谈进行定性研究。
英格兰东北部。
18 名公众参加焦点小组，11 名医疗保健和服务提供者（6 名护理人员和 5 名代表心脏病学、全科医学、公共卫生、研究、政策和委托的专家）进行一对一在线访谈。
所有参与者群体都支持 EMS 在识别 AF 作为常规评估的一部分并使对 AF 检测的反应正式化方面发挥作用。然而，这不应给 EMS 造成延迟，因为控制心率的 AF 不是紧急情况，并且存在替代的社区机制来管理它。公众参与者担心 AF 诊断的沟通，以及是否应在“现场”或在随后的 GP 预约中进行。护理人员报告经常偶然发现 AF，但并不总是清楚“现场”这是否是新的诊断，并且在关于是否（以及如何）将其传达给 GP 的实践中存在差异。护理人员还侧重于确保未转运患者的安全，并认为需要进行“主动”报告过程，以便对 AF 的发现采取行动。现场专家认为正式途径将是有用的，并赞成一种简单的干预措施，而不会不必要地增加时间压力。
支持制定正式途径，以确保由 EMS 偶然检测到的 AF 患者得到随访。这有可能提高抗凝治疗率并降低中风风险。
