Brik Tessa, Niekel Marilou S, Bak Marieke A R, Himmelreich Jelle C L, Harskamp Ralf E, Moll van Charante Eric P
Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
BMJ Open. 2025 Jul 24;15(7):e102160. doi: 10.1136/bmjopen-2025-102160.
European cardiovascular guidelines recommend systematic atrial fibrillation (AF) screening in community-dwelling high-risk patients. However, little is known about the impact of abnormal screening findings, including AF and non-AF incidental findings on the target population. This gap highlights the need to assess both the benefits and potential harms from patients' perspectives to fully understand the impact of AF screening. Therefore, the aim of this study is to explore patients' experiences with AF screening among those who received abnormal findings from ambulatory ECG monitoring.
We conducted a qualitative study using semistructured interviews, analysed thematically. Participants in the PATCH-AF trial, based in Amsterdam primary care, were purposively sampled based on their screening results (AF or non-AF incidental findings), sex and socioeconomic status.
We achieved data saturation after conducting 16 interviews (6 with interviewees diagnosed with AF and 10 with non-AF incidental findings). Participants had a median age of 76 (73-79) years, and 56% were male. Their experiences, whether positive or negative, fluctuated throughout the screening process and depended on their initial motivations for participation in AF screening (seeking extra health checks, finding explanations for pre-existing symptoms or contributing to medical research), expectations and perceived benefits from clarification, diagnostic workup or treatment. Influencing factors included the type of finding (AF or non-AF incidental finding), healthcare provider communication and individual characteristics such as age, socioeconomic status and medical history.
This qualitative study highlights both positive and negative AF screening experiences from the patients' perspective. It underscores how patients' motivations and expectations for participation, the type of ambulatory ECG finding and communication and follow-up by healthcare providers shape their overall experiences. Healthcare providers should be aware of these factors to optimise screening consultations. Clear guidelines on communicating abnormal ambulatory ECG findings, especially incidental findings, are warranted.
The Netherlands Trial Register (NTR) number NL9656.
欧洲心血管指南建议对社区高危患者进行系统性心房颤动（AF）筛查。然而，对于异常筛查结果（包括房颤及非房颤偶然发现）对目标人群的影响知之甚少。这一差距凸显了从患者角度评估房颤筛查的益处和潜在危害以全面了解其影响的必要性。因此，本研究旨在探讨动态心电图监测结果异常的患者接受房颤筛查的体验。
我们采用半结构化访谈进行了一项定性研究，并进行了主题分析。基于阿姆斯特丹初级保健机构的PATCH-AF试验参与者，根据其筛查结果（房颤或非房颤偶然发现）、性别和社会经济地位进行了有目的的抽样。
在进行了16次访谈后（6次访谈对象被诊断为房颤，10次访谈对象有非房颤偶然发现），我们达到了数据饱和。参与者的中位年龄为76（73 - 79）岁，56%为男性。他们的体验，无论是积极的还是消极的，在整个筛查过程中都会波动，并且取决于他们参与房颤筛查的初始动机（寻求额外的健康检查、为既往症状寻找解释或为医学研究做出贡献）、期望以及从澄清、诊断检查或治疗中感知到的益处。影响因素包括发现的类型（房颤或非房颤偶然发现）、医疗服务提供者的沟通以及年龄、社会经济地位和病史等个体特征。
这项定性研究从患者角度突出了房颤筛查的积极和消极体验。它强调了患者参与的动机和期望、动态心电图检查结果的类型以及医疗服务提供者的沟通和后续跟进如何塑造他们的整体体验。医疗服务提供者应意识到这些因素以优化筛查咨询。关于传达动态心电图异常结果（尤其是偶然发现）的明确指南是必要的。
荷兰试验注册（NTR）编号NL9656 。
