Background Atrial fibrillation (AF) is a common arrhythmia and a significant risk factor for stroke. Oral anticoagulants (OACs) substantially reduce the risk of stroke in people with AF. Many people have undiagnosed and untreated AF and remain at elevated risk of stroke. Sometimes AF is incidentally detected during routine assessment and non-conveyed patients may be referred for further investigation. Formalising this response to opportunistic identification of AF should lead to more timely prescription of OACs and a reduction in avoidable strokes. This study explored the acceptability and feasibility of opportunistic health screening for incidental AF in non-conveyed patients by ambulance clinicians.

Methods Online one-to-one interviews with healthcare and service providers, and focus groups involving members of the public. Purposive sampling aimed to maximise the diversity of perspective and experience. Data were audio-recorded, transcribed anonymously, and analysed thematically.

Results We conducted 11 interviews with paramedics and other healthcare and service providers and four focus groups involving 18 members of the public. All participant groups were in favour of formalising a pathway for actioning the opportunistic detection of new AF, but each had concerns and caveats. Members of the public were concerned about how the diagnosis would be communicated. Concerns for paramedics focussed on safety-netting non-conveyed patients and ensuring that AF was followed up. Field experts favoured identifying failures in current processes to determine what intervention or change is required. All participant groups expressed concern that any change in practice mustn’t create delays in the emergency response system since AF is usually non-urgent.

Conclusion Opportunistic identification of AF by ambulance clinicians was supported by participants but concerns were expressed around communicating the identification of AF to patients, the need for evidence on the effectiveness of current referral pathways and how this public health screening fitted with the role of the ambulance service.