The Patient Path to a diagnosis of Atrial Fibrillation: a qualitative study in primary care (P-PAF)

heart rhythm 12The P-PAF study is a qualitative study which aims to explore the patient path to a diagnosis of atrial fibrillation and develop resources to help improve the detection of atrial fibrillation.

Atrial fibrillation (AF) is a heart condition that causes an irregular heartbeat which can be difficult to detect. New research has shown more patients have symptoms than previously thought, and that patients with symptoms experience delay in getting a diagnosis.

The study aims to explore patients’ experiences of getting a diagnosis of atrial fibrillation and develop educational resources to help improve the detection of atrial fibrillation. The study will be conducted in up to 20 GP practices in the West Midlands.

This study is funded by NIHR  and developed in partnership with the Atrial Fibrillation Association.

Key researchers

Patricia Apenteng

Dr Patricia Apenteng

Chief Investigator

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Project description


Atrial fibrillation is a heart rhythm disorder affecting approximately 10% of people aged over 65 years.  Atrial fibrillation increases the risk of stroke five-fold and doubles the risk of death.  Fortunately, anticoagulation therapy dramatically reduces these risks.  The detection of atrial fibrillation is challenging because atrial fibrillation can be intermittent and not all patients experience symptoms.  Also, patients may think some of the symptoms are trivial and clinicians do not always associate them with AF.  Therefore, patients experience a delay in diagnosis and one third of patients with atrial fibrillation are undiagnosed, equating to 500,000 people in the UK. 

This study aims to explore patient journeys to AF diagnosis to better understand the different ways in which AF presents and the barriers to diagnosis.  The knowledge gained from the study will help people to recognise symptoms earlier and seek medical help.  It may also help healthcare professionals to better recognise AF.


1.    To explore the experiences and perceptions of patients of the journey to a diagnosis of AF.

2.    To explore the knowledge and experiences of primary care health professionals on detection of AF.

3.    To hold a workshop with stakeholders to identify key messages to improve awareness and recognition of AF from study findings.

4.    To develop, in collaboration with PPI educational resources aimed at the public and health professionals from findings.


There are 4 stages of the study:

1.    Interviews with patients with a recent diagnosis of atrial fibrillation (Objective 1).

2.    Interviews with primary healthcare professionals (Objective 2).

3.    Stakeholder workshop to interpret findings (Objective 3).

4.    Development of educational resources for healthcare professionals and the public (Objective 4).

Patient and public involvement

This study was developed in partnership with the Atrial Fibrillation Association.  We also consulted three patients with atrial fibrillation during the development of the study.  Mrs Trudie Lobban, Founder and CEO of the Atrial Fibrillation Association is a co-investigator and a member of the project management team.  Two patients with AF have been recruited to work along Mrs Lobban to provide insight from the patient and public perspective at each stage of the project.

Meet the team

Chief Investigator: 


Project Manager:

  • Mrs Pamela Nayyar

For any enquiries, please contact Dr Patricia Apenteng


Dr Apenteng presented a poster of the study methods at the Society of Academic Primary Care (SAPC) South West Regional conference in March 2023.

Download the poster


The protocol has been posted online on Protocol Exchange: