PALP-AF: turning “what works” into “what helps” for people living with atrial fibrillation, by Dr Rosina Cross, Dr Sinead McDonagh & Professor Christopher Clark

Posted by ma403

10 February 2026

What is Atrial Fibrillation and why does it matter?

Atrial fibrillation (AF) is a common heart condition. It increases risk of developing other conditions, like heart failure, or having a stroke and dying early. For many people, AF can be frightening and confusing. People with AF often describe a constant daily balancing act between making sense of symptoms, worrying about what might trigger them, trying to make changes to lifestyle and habits, and dealing with advice that can feel overwhelming, inconsistent, or hard to fit into everyday life.

Over the past 18 months, the PALP-AF programme has focused on one simple but important question:

How can we turn research evidence about lifestyle and self-management in AF into guidance delivered in primary care that is helpful, trustworthy, and supportive for patients?

We addressed this through two linked strands of work:

An umbrella review – bringing together existing evidence on lifestyle and self-management interventions for adults with AF.
A structured co-production process with our patient and public involvement and engagement (PPIE) group (which includes people living with AF and caregivers). We shared plain-language evidence summaries of the lifestyle and self-management interventions found in the umbrella review with our PPIE group. Through reviewing of documents and workshop discussions, repeated feedback from our PPIE group helped us refine these self-help evidence summaries so that they are patient-focussed, reflect real-world experience and are relevant, accessible and inclusive.

This blog shares what we’ve learnt so far, and importantly why the next phase of the work matters.

Step 1: What does the evidence tell us?

Our umbrella review looked at systematic reviews and meta-analyses of lifestyle and self-management interventions for AF.

Overall, the evidence suggests:

Moderate physical activity, including aerobic exercise and yoga, can improve AF symptoms, fitness (exercise capacity), and quality of life.
High-intensity endurance (long duration) exercise and higher alcohol intake may increase AF risk for some people. This highlights the importance of personalised rather than ‘one-size-fits-all’ advice.
Managing risk factors (like blood pressure, smoking, alcohol use, sleep apnoea, diet and weight) along with psychological or digital support, can lead to moderate improvements in AF symptoms, mental health, quality of life, and taking medication as prescribed (adherence).
Successful lifestyle interventions often include behavioural components such as self-monitoring, goal setting, motivational interviewing, and help with decision making.

In summary, lifestyle changes and self-management support can help people living with AF to live better, but there are still uncertainties around safety, how to tailor advice, and how best to explain this information to patients.

This leads to a key implementation challenge:

Even when evidence exists, how do we present it and share it in ways that people can understand and use, ensuring it is accessible and inclusive, without increasing anxiety, blame, or confusion around AF?

Step 2: Co-producing guidance that works in real life

Evidence alone doesn’t create a self-help resource. People do.

We ran six online PPIE workshops (2024–2025) with people living with AF and caregivers. Together, we reviewed plain-language evidence summaries on topics including physical activity, blood pressure monitoring, alcohol, smoking and caffeine, anticoagulation, diet and weight, and stress, anxiety, and depression.

Using a person-based, evidence-informed approach, PPIE contributors shaped the content through repeated discussion and feedback, with changes documented transparently.

Four consistent shifts emerged:

From prescriptive advice to supportive, non-judgemental wording, particularly around weight, alcohol, and activity.
Recognising the emotional impact of AF, including fear and uncertainty, without turning typical reactions to being diagnosed, and living with, AF, into medical problems, while keeping clear safety advice.
Clearer explanations of blood pressure and anticoagulation, so people can make informed decisions rather than just follow instructions.
Strong support for blood pressure self-monitoring as practical and empowering, if guidance is clear and expectations are realistic.

This feedback reshaped the content and purpose of the AF evidence summaries and resource plans. It couldn’t be just another leaflet telling people what they should do, but a ‘guide’ that helps them make sense of AF and take personalised, manageable, safe steps to AF self-care that fit their own lives.

What we’ve learned: implementation is the missing middle

PALP-AF has produced a strong evidence base and a series of co-produced, patient-led evidence summaries. What we still don’t know is how best to use this wealth of information for AF self-help in everyday primary care – it must be introduced at the right time, by the right person, and in formats that support equity rather than widening existing health inequalities.

The gap between this evidence and everyday primary care practice is the “missing middle”.

Our next phase of research will focus on adapting the PALP-AF resource so it can be delivered in ways that are practical, acceptable, scalable and equitable in primary care settings.

The next step is not about finding or generating more evidence, it’s about making evidence more usable, with real-world primary care delivery, acceptability, equity, and patient co-development at the centre.

Where next—and how you can follow (or support) the work

In the next phase of research, we aim to bring together learning from:

national surveys and interviews with patients and different types of primary care health professionals to understand more about how we can deliver our AF self-help resource at scale in this setting
barriers and enablers to signposting and support in real primary care pathways,
and questions around health literacy, format, timing (for example, at diagnosis or follow-up), and equity.

Stay tuned…

If you’re a patient, caregiver, healthcare professional, or researcher with interest in AF self-management in primary care, we’d love to connect:

Dr Rosina Cross, Dr Sinead McDonagh & Professor Christopher Clark