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Investigation into financial conflicts of interest and screening for atrial fibrillation in the UK: a cross-sectional study
  1. Margaret McCartney1,
  2. Calum McCutcheon2,
  3. Millie Cooke3,
  4. Ronald MacDonald1,
  5. Lena Mekwi2,
  6. Ummi Haji Noruddin2,
  7. Mary O'Keeffe4
  1. 1 School of Medicine, University of St Andrews, St Andrews, UK
  2. 2 Medical School, University of Glasgow, Glasgow, UK
  3. 3 Freelance journalist, UK, UK
  4. 4 Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Margaret McCartney, University of St Andrews, St Andrews, UK; mm494{at}


Objective To understand the relationship between financial conflicts of interest and recommendations for atrial fibrillation (AF) screening in the UK, via examining (1) if the UK media recommend for or against screening for AF, and (2) the financial conflicts of interests of AF screening commentators.

Design Cross-sectional study.

Setting/participants References in UK mainstream media, Twitter, the UK’s National Health Service (NHS), patient information websites and major UK heart-related charities regarding screening for AF between1 January 2018 and 31 July 2021.

Outcome measures Proportion of references advocating for, against and presenting balanced/neutral views on screening. Proportion of references citing commentators with financial conflicts of interest.

Results 217 media stories were identified, containing 284 comments about screening for AF. 185/217 (85.3%) of articles were in favour, 9 (4.1%) were against and 23 (10.6%) were balanced. Quotations within were located from 194 commentators; 44 were quoted more than once. 41/44 (93.2%) were in favour of screening. Of these 41, 37 (90.2%) had a direct or indirect financial conflict of interest, including that due to a work role. Two were balanced and one was negative. 2553 tweets using 3 hashtags promoting screening were analysed. 2119 (83%) of the most impactful tweets promoting AF screening were by industry or organisations with industry funding. Of 23 NHS organisations holding information about funding and promoting AF screening online, 22 (96%) had industry funding. 9 (90%) of the top 10 patient information websites promoting AF screening had industry funding. Four main UK patient charities in this sector promoting screening received industry funding.

Conclusions The vast majority of UK media promotes screening for AF, in contrast to the position of the independent UK National Screening Committee, which recommends against screening. Most commentators, internal NHS organisations and UK charities promoting screening had a direct or indirect financial conflict of interest. Independent information was rare. The reasons for this are unknown. Readers should consider the potential for the impact of financial conflicts on recommendations to screen.

  • health policy
  • clinical governance
  • arrhythmias, cardiac
  • public health
  • primary healthcare

Data availability statement

Data are available in a public, open access repository. McCartney, Margaret (2022): Atrial Fibrillation screening study - BMJ EBM. figshare. Collection.

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Data availability statement

Data are available in a public, open access repository. McCartney, Margaret (2022): Atrial Fibrillation screening study - BMJ EBM. figshare. Collection.

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  • Twitter @mgtmccartney

  • Contributors The idea was conceived by MM, and agreed and discussed with MM and MO'K. CM and MC did most data searching, capture and analysis, with LM and UHN doing limited amounts of data searching, capture and analysis. MM and MO'K did data analysis, and drafted and edited the paper. MM is the guarantor.

  • Funding A grant from Healthwatch (now called Healthsense), a charity interested in evidence-based medicine paid a studentship fee to CM and MC. RM had a student summer grant from the University of St Andrews. MM has a Chief Scientist Office (Scotland) fellowship.

  • Competing interests MM has written and campaigned around issues related to conflicts of interest. She has been paid (written and broadcast journalism/books) for some of this.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.