The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

Abstract

Background Early diagnosis and continuity of care is vital for atrial fibrillation (AF), a major risk factor for stroke that requires regular monitoring when treated with warfarin; however, evidence on AF care in LMICs is lacking. We aimed to identify the AF patient pathway in Northern Province, Sri Lanka and to determine how the COVID-19 pandemic impacted AF care. Methods This descriptive longitudinal study utilised two questionnaires, which were previously used in India and Mongolia to quantitatively evaluate the AF pathway: one at baseline and one ≥3 months following baseline. Adults (≥18 years) with AF were recruited from the A&E department and outpatient clinics located at the Jaffna Teaching Hospital, the only tertiary hospital with cardiologists and 12-lead echocardiogram facilities in the Province. Data were collected between October 2020 and June 2021 and analysed using descriptive statistics. Results This study included 151 participants (median age 57 years, IQR 49-67; 70% female). Most participants were diagnosed in the A&E (38%) or inpatient department (26%), followed by an outpatient department (19%) or private facility (16%). Nearly all (97%) participants received follow-up care during the study period, with an average of 1.3 AF-related healthcare visits per person; most visited an outpatient department (88%). The COVID-19 pandemic negatively impacted 39% of participants’ care: fewer healthcare visits, delayed or unattainable medications, and longer intervals between blood tests; however, 24% of participants received their medication by ambulance, public health staff or post. Conclusions Primary care was not involved in the diagnosis of AF, leading to most diagnoses occurring after a medical emergency. The frequency of blood tests was lower than guideline recommendations and could in-part be due to the adverse impacts of the pandemic. Strengthening primary and community-based care may enable early diagnosis and improve continuity of care during and beyond future healthcare crises/emergencies.