P4470Atrial fibrillation screening in general practice by clinical pharmacists using pulse palpation and single-lead ECG during the influenza vaccination season: a multi-site feasibility study

Abstract

Background: Atrial fibrillation (AF) affects up to 10% of the population aged 65 or over, however many are asymptomatic and may present with cardioembolic stroke as the first symptom. Clinical pharmacists in general practices (GPs) are ideally placed to conduct timely, opportunistic AF screening. Purpose(s): The aim of this study was to assess the feasibility and accuracy of clinical pharmacists based in GPs to detect and diagnose patients for AF. Method(s): 4 GPs and 7 clinical pharmacists in Kent (UK) were engaged to test this initiative. Pharmacists were trained by a cardiologist to pulse palpate and to record and read single-lead electrocardiogram (ECG). Any persons aged 65 years or older attending an influenza (flu) vaccination clinic at a GP, who did not have a pacemaker were offered a free heart rhythm check with the pharmacist. After written consent, each participant had their pulse palpated for 1 min, followed by a 30 sec ECG and a provisional diagnosis. All ECGs were overread by a cardiologist within 72 hrs and any irregularities detected were followed up by the GP. Result(s): A total of 297 eligible participants were recruited from flu clinics between November 2017 and February 2018. The mean age of participants was 73 years (44% male). AF was identified by the cardiologist in 14 participants (5%) with a mean CHA2DS2-VASc of 4. A further 25 (8%) of the ECGs required further investigation. The pharmacist's and device interpretations of ECGs displayed greater agreement with the cardiologist's interpretation compared to pulse palpation alone (Table 1). The feedback from service users was positive with 91% of respondents (n=214) rating the service as "very good" and 9% as "good". Participants praised the informative, quick and efficient screening process. (Table presented) Conclusion(s): Evidence gathered during this study supports AF screening by GP-based clinical pharmacists. The use of a mobile ECG device led to fewer misdiagnoses compared to traditional pulse palpation. Ongoing research will evaluate the cost-effectiveness of this screening approach and the feasibility of its integration into existing cardiovascular services.