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Arrhythmias and sudden death
Original research article
High prevalence of modifiable stroke risk factors identified in a pharmacy-based screening programme
  1. Roopinder K Sandhu1,
  2. Lisa Dolovich2,
  3. Bishoy Deif3,
  4. Walid Barake1,
  5. Gina Agarwal2,
  6. Alex Grinvalds3,
  7. Ting Lim3,
  8. F Russell Quinn4,
  9. David Gladstone5,
  10. David Conen6,
  11. Stuart J Connolly3 and
  12. Jeff S Healey3
  1. 1Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
  2. 2Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
  3. 3Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  4. 4Division of Cardiology, University of Calgary, Calgary, Alberta, Canada
  5. 5Division of Neurology, University of Toronto, Toronto, Ontario, Canada
  6. 6Division of Internal Medicine, University Hospital, Basel, Switzerland
  1. Correspondence to Dr Roopinder K Sandhu; rsandhu2{at}ualberta.ca

Abstract

Background Population-based screening for atrial fibrillation (AF) is a promising public health strategy to prevent stroke. However, none of the published reports have evaluated comprehensive screening for additional stroke risk factors such as hypertension and diabetes in a pharmacy setting.

Methods The Program for the Identification of ‘Actionable’ Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy) screened individuals aged ≥65 years, attending community pharmacies in Canada, who were not receiving oral anticoagulation (OAC). Participants were screened for AF using a hand-held ECG device, had blood pressure (BP) measured, and diabetes risk estimated using the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) questionnaire. ‘Actionable’ AF was defined as unrecognised or undertreated AF. A 6-week follow-up visit with the family physician was suggested for participants with ‘actionable’ AF and a scheduled 3-month visit occurred at an AF clinic.

Results During 6 months, 1145 participants were screened at 30 pharmacies. ‘Actionable’ AF was identified in 2.5% (95% CI 1.7 to 3.6; n=29); of these, 96% were newly diagnosed. Participants with ‘actionable AF’ had a mean age of 77.2±6.8 years, 58.6% were male and 93.1% had a CHA2DS2-VASc score ≥2. A BP>140/90 was found in 54.9% (616/1122) of participants and 44.4% (214/492) were found to be at high risk of diabetes. At 3 months, only 17% of participants were started on OAC, 50% had improved BP and 71% had confirmatory diabetes testing.

Conclusions Integrated stroke screening identifies a high prevalence of individuals who could benefit from stroke prevention therapies but must be coupled with a defined care pathway.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000515

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    Footnotes

    • Funding The PIAAF-Pharmacy study was supported by the Canadian Stroke Prevention Intervention Network, Boehringer Ingelheim and in-kind support from CardioComm. RKS received a grant from the University Hospital Foundation. JSH has a personnel award from the Heart and Stroke Foundation, Ontario Provincial office (MC7450).

    • Competing interests FRQ has received consulting fees from Boehringer Ingelheim and Servier and has research grants from Boehringer Ingelheim and Bayer. DC has consulting fees from Daiichi-Sankyo, Boehringer Ingelheim, Bayer, Pfizer and Bristol-Myers Squibb; research grants from Daiichi-Sankyo, Boehringer Ingelheim, Bayer, Pfizer and Bristol-Myers Squibb. SJC receives consulting fees from Bristol-Myers Squibb and JSH has research grants from Boehringer Ingelheim, Bayer, Pfizer and Bristol-Myers Squibb.

    • Ethics approval Human Research Ethics Committee.

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

    • Data sharing statement No additional data are available.