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Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol
  1. Jessica J Orchard1,
  2. Lis Neubeck2,
  3. Ben Freedman1,3,
  4. Ruth Webster4,
  5. Anushka Patel4,
  6. Robyn Gallagher5,
  7. Jialin Li5,
  8. Charlotte Mary Hespe6,
  9. Caleb Ferguson7,
  10. Nicholas Zwar8,
  11. Nicole Lowres1,3
  1. 1 Sydney Medical School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
  2. 2 School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
  3. 3 Heart Research Institute, Sydney, New South Wales, Australia
  4. 4 The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
  5. 5 Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
  6. 6 General Practice Research, School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
  7. 7 Western Sydney Nursing and Midwifery Centre, Western Sydney University and Western Sydney Local Health District, Sydney, New South Wales, Australia
  8. 8 School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
  1. Correspondence to Jessica J Orchard; jessica.orchard{at}


Introduction Screening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified.

This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach.

Methods and analysis Screening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3–4 months during 2018–2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a ‘control’ dataset of practices.

Ethics and dissemination Ethics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations.

Trial registration number ACTRN12618000004268; Pre-results.

  • atrial fibrillation
  • screening
  • oran anticoagulants
  • electronic decision support

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors LN, BF, NL and JO conceived the original concept of the study. JO, LN, NL, BF, CMH, CF, RG and NZ were involved in the design of the study. LN provided qualitative analysis expertise and NL provided cost-effectiveness analysis expertise. RW and AP were involved in the design and testing of the electronic study apps and provided statistical expertise. JO, LN, BF, JL and NL were involved in drafting the article. CMH and NZ provided input on general practice aspects of study design, including in relation to educational materials for practices. JO, LN, BF, RW, AP, RG, JL, CF, NZ and NL contributed to the critical revision of the drafting and final approval of the manuscript.

  • Funding This work was supported by a National Heart Foundation of Australia/ New South Wales Health Cardiovascular Research Network Research Development Project Grant (101133) with top-up funding to complete the study in rural NSW through an investigator-initiated grant from Pfizer. AliveCor has provided free Kardia devices for study purposes. JO is supported by an Australian Government Research Training Program (RTP) Scholarship. RW is funded by an NHMRC Early Career Fellowship (APP1125044). NL is funded by an NSW Health Early Career Fellowship (H16/ 52168).

  • Disclaimer The funders have no influence on study design, data collection or the decision to submit reports for publication.

  • Competing interests NL and BF report grants from BMS/Pfizer during the conduct of the study. RW and AP report other financial interests from George Health, outside the submitted work. CF reports personal fees from Pfizer outside the submitted work. LN reports grants from Pfizer/BMS and Boehringer Ingelheim outside the submitted work. BF reports prior fees and advisory board honoraria from Bayer Pharma AG, Boehringer Ingelheim, and BMS/Pfizer but for the past year has removed himself from pharmaceutical advisory boards and receives speaker fees only for accredited educational meetings.

  • Patient consent Not required.

  • Ethics approval Approval for the study was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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