Edinburgh Napier University

  Aims
To understand for whom, under what conditions, and how an integrated approach to atrial fibrillation service delivery works (or does not work).

Methods and Results
A realist review of integrated approaches to atrial fibrillation service delivery for adult populations aged ≥18 years. An expert panel developed an initial programme theory, searched and screened literature from four databases until October 2022, extracted and synthesised data using realist techniques to create context–mechanism–outcome configurations for integrated approaches to atrial fibrillation service and developed an integrated approach refined programme theory. 5,433 documents were screened and 39 included. The refined programme theory included five context–mechanism–outcome configurations for how clinical and system wide outcomes are affected by the way integrated approaches to atrial fibrillation service delivery are designed and delivered. This review identifies core mechanisms underpinning the already known fundamental components of integrated care. This includes having a central coordinator responsible for service organisation to provide continuity of care across primary and secondary care ensuring services are patient centred. Additionally, a fifth pillar Lifestyle and Risk Factor reduction should be recognised within an AF care pathway.

Conclusion
It is evident from our provisional theory that numerous factors need to interlink and interact over time to generate a successfully integrated model of care in AF. Stakeholders should embrace this complexity and acknowledge that the learnings from this review are integral to shaping future service delivery in the face of an ageing population and increased prevalence of AF.