Using the RE-AIM framework to evaluate the implementation of opportunistic atrial fibrillation screening in primary care

Background/Introduction

Atrial fibrillation (AF) is a leading cause of stroke, yet detection remains inconsistent. Opportunistic AF screening within routine care within primary care settings offers potential for early identification and prevention. This study evaluated the implementation and sustainability of a multi-practice AF screening programme using the RE-AIM framework.

Purpose

To evaluate the implementation, reach, and outcomes of a primary care AF screening programme delivered as part of a preventive care pathway.

Methods

A primary care opportunistic AF screening programme was implemented across general practices. Participants (n=2,819) were screened for suspected AF, 19 practices were approached; ten joined initially and four later through device reallocation, giving 14 participating practices. The five dimensions of RE-AIM, (reach, effectiveness, adoption, implementation, and maintenance) were assessed using data sources (e.g., practice staff, costing and) obtained through the study period. Quantitative data were analysed descriptively; qualitative feedback captured contextual barriers and adaptations.

Results

Overall, the AF screening programme reached approximately 1.9% of registered patients across the participating general practices in Northamptonshire. Despite modest coverage, participants were broadly representative of the population (White participants 71.4% vs. 80.7% practice average), with the most frequently screened demographic being White females aged 45–64 years (14.08%).

Suspected AF was identified in 123 participants (4.4%). Of these, 86.2% were booked for ECG, 11.3% confirmed AF (true positives), 2741% false positives, and 61.3% lacked ECG data. Detection increased with age (χ² = 35.74, p < 0.001, Cramer’s V = 0.11); no sex or ethnicity difference observed.

Fourteen practices participated; nine provided data (64 %). Five (35.7 %) withdrew, mainly due to capacity or management changes. Screening was successfully integrated into routine care workflows, including flu and COVID-19 vaccination clinics, phlebotomy sessions, and opportunistic reception-led checks. Core fidelity to the screening protocol was consistent. The mean data completeness across practices was 90.9%, though specific domains varied; demographic fields were highly complete (>98%), but the mean completeness for ECG results was only 68.5%, highlighting gaps in follow-up recording. Several practices continued screening beyond the evaluation period.

Conclusion(s)

Based on a detailed and comprehensive RE-AIM evaluation, the AF screening programme appears to be a feasible approach to early identification of AF and supporting prevention of the development of heart failure and stroke