Screening for AF Survey - 2016 Question Title * 1. Please select your age bracket: (Required.) 18-24 25-30 31-40 41-50 51-60 61-70 71-80 81+ Question Title * 2. Please indicate your gender: (Required.) Male Female Question Title * 3. Please select the country you reside in: (Required.) Australia Canada China England France Germany India Indonesia Ireland Japan New Zealand Poland Scotland South America Spain Africa Sweden Turkey UK USA Wales Other Other – please state Question Title * 4. Please specify which condition you have been diagnosed with: (Required.) Atrial fibrillation Atrial flutter No diagnosis Question Title * 5. Were you ever screened for AF (routine pulse check/ECG/EKG)? Yes No Question Title * 6. Please share more about how your atrial fibrillation or flutter was detected. Did a screening program detect it, or would one have caught it more quickly? (Required.) Question Title * 7. Do you have any thoughts about screening for atrial fibrillation or flutter and how we can make sure that people are screened and detected quickly? Question Title * 8. Please state, as accurately as possible, the length of time between first being aware of symptoms (such as palpitations) to diagnosis: (Required.) Question Title * 9. If you are still awaiting diagnosis, what do you think is delaying this? Question Title * 10. What symptoms do you experience (please select all which apply): (Required.) Anxiety Breathlessness Chest pains Excess sweating Fatigue Palpitations Passing too much urine / frequent need to urinate Syncope (fainting/loss of consciousness) Light headed N/A Other (please specify) Question Title * 11. Have you experienced a TIA or stroke? (Required.) Yes No Next
