Pharmacists detecting atrial fibrillation (PDAF) in primary care during the influenza vaccination season: a multisite, cross-sectional screening protocol

Veale, Emma L.; Stewart, Adrian; Mathie, Alistair; Lall, Satvinder K; Rees-Roberts, Melanie; Savickas, Vilius; Bhamra, Sukvinder K.; Corlett, Sarah

doi:10.1136/bmjopen-2017-021121

Cited by 12 publications

(10 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Screening was conducted over two influenza vaccination seasons, from 28 October 2017 to 22 February 2018 and then from 2 October to 14 December 2018. The study protocol design was described in a previous publication [ 33 ]. In brief, five clinical pharmacists were recruited from Kent Community NHS Foundation Trust, another pharmacist was already embedded in a participating practice, and another was provided by the Medway School of Pharmacy, University of Greenwich and Kent.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: A cross-sectional feasibility study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Growing prevalence of atrial fibrillation (AF) in the ageing population and its associated life-changing health and resource implications have led to a need to improve its early detection. Primary care is an ideal place to screen for AF; however, this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice–based clinical pharmacists to screen the over-65s for AF, using digital technology and pulse palpation during the influenza vaccination season. Methods and findings Screening was conducted over two influenza vaccination seasons, 2017–2018 and 2018–2019, in four GP practices in Kent, United Kingdom. Pharmacists were trained by a cardiologist to pulse palpate, record, and interpret a single-lead ECG ( SL ECG). Eligible persons aged ≥65 years (y) attending an influenza vaccination clinic were offered a free heart rhythm check. Six hundred four participants were screened (median age 73 y, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); be older; have an increased body mass index (BMI); and have a CHA 2 DS 2 -VASc (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke, Vascular disease, Age 65–74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% (95% confidence interval [CI] 56.4–91.0) and 92.2% (95% CI 89.7–94.3), respectively. This rose to 88.5% (95% CI 69.9–97.6) and 97.2% (95% CI 95.5–98.4) with an SL ECG. At follow-up, four participants (0.7%) were diagnosed with new AF and three (0.5%) were initiated on anticoagulation. Screening with SL ECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SL ECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. Conclusions This study demonstrates that AF screening performed by GP practice–based pharmacists was feasible, economically viable, and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using an SL ECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing th...

show abstract

Section: Methodsmentioning

confidence: 99%

“…Apart from the subgroup analysis pertaining to enhanced demographic data of selected participants with suspected ‘normal’ diagnoses, all data analyses were conducted as prespecified in the study protocol [ 33 ]. Continuous variables were reported as a median (interquartile range).…”

Section: Methodsmentioning

confidence: 99%

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: A cross-sectional feasibility study

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Focus groups were conducted to ascertain the perspectives of three stakeholder groups: patients, GPS, and CPs. 26 This method is commonly used in qualitative research and generates rich data to shape complex healthcare interventions. 29,30 Stakeholders were recruited using convenience sampling, and all interested individuals were invited to participate.…”

Section: Methodsmentioning

confidence: 99%

“…PDAF was a multi-site study in UK general practice surgeries, which determined the impact of CP-led AF screening using either conventional pulse palpation or novel single-lead ECG devices during the influenza vaccination season (reported elsewhere). 26 , 27 This study constitutes a qualitative stakeholder evaluation of the PDAF intervention, 28 and identifies facilitators and barriers to its implementation focusing on the novel role of pharmacists in general practice.…”

Section: Introductionmentioning

confidence: 99%

Pharmacists detecting atrial fibrillation in general practice: a qualitative focus group study

et al. 2020

Self Cite

View full text Add to dashboard Cite

BackgroundAtrial fibrillation (AF) affects up to 10% of people aged ≥65 years, yet a third of all cases remain undetected. Practice-based pharmacists are in an ideal position to facilitate opportunistic AF screening, while increasing general practice capacity at a time of workforce crisis.AimTo explore the perspectives of three stakeholder groups involved in the ‘Pharmacists Detecting Atrial Fibrillation’ (PDAF) study to elucidate the facilitators and barriers to pharmacist-led AF screening in general practice.Design & settingA qualitative study took place, comprising homogeneous focus groups with stakeholders in Kent, UK.MethodThe stakeholder groups — patients, general practice staff (GPS), and clinical pharmacists (CPs) — were recruited using convenience sampling. Audio-recordings were transcribed verbatim and analysed using a deductive Theoretical Domains Framework (TDF) approach.ResultsTwenty-five patients, four pharmacists, and nine practice staff participated in six focus groups. Three main themes were identified: knowledge and awareness; prioritisation of resources; and environmental considerations. The public’s lack of awareness of AF-related risks and pharmacist-led screening services was highlighted. Practice-based pharmacists were perceived as an underutilised educational resource which, together with novel electrocardiogram devices, enabled convenient access to screening while reducing GPs’ workload. Participants agreed that AF screening should be incorporated into personalised health checks and at-risk groups should be prioritised, such as care home residents. Patients favoured the general practice environment over the community pharmacy where concerns of privacy, staffing, and commercialisation were raised.ConclusionThe findings of this study support the introduction of pharmacist-led AF screening programmes in general practice surgeries. Commissioners should consider the added value of utilising CPs and focus on the delivery of AF screening within an integrated service.

show abstract

“…The mECG device has been used in a variety of ambulatory settings to detect arrhythmias and conduction system abnormalities such as atrial fibrillation, prolonged QT intervals, and myocardial infarction . These studies largely depended on single lead measurements, which provide only a fraction of the information available from multi‐lead analysis.…”

Section: Introductionmentioning

confidence: 99%

Improved accuracy and confidence with multiple‐lead recordings from a single‐lead mobile electrocardiographic device

Frisch

Weiß

Dikdan

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background Mobile electrocardiograms (mECGs) utilizing smartphone applications are an emerging technology. Typically, a Lead I rhythm strip is recorded. However, interpretation can be difficult in patients with sinus rhythm and low amplitude P‐waves (SR‐LAP) or atrial flutter (AFL). We hypothesized that patients could independently obtain multi‐lead tracings using a commercial mECG device, and that cardiologists who interpreted the multi‐lead tracings would make more accurate diagnoses and have more confidence in their interpretation compared to a single lead only. Methods Thirty sets of recordings were obtained from 10 patients with either SR‐LAP or AFL that was not apparent on Lead I on a standard ECG. Patients recorded Lead I, Lead II, and Lead V1 tracings using AliveCor's KardiaMobile mECG device. Twenty‐nine cardiologists reviewed each patient's Lead I tracing, multi‐lead tracings (Leads I, II, V1), and 12‐lead ECG. Accuracy was noted and each cardiologist rated their level of confidence in their interpretation. Results All patients were able to record their own single and multi‐lead tracings. Single lead, multi‐lead, and the 12‐lead ECG yielded 36.4%, 84.3%, and 97.7% agreement with the established diagnosis, respectively (P < .01 for each comparison). Overall mean confidence scores (out of a score of 5) were 2.95, 3.50, and 4.47 for single lead, multi‐lead, and the 12‐lead ECG, respectively (P < .01 for each comparison). Conclusions Patients were able to record their own multi‐lead mECG tracings. Compared to a single lead recording, multi‐lead mECGs significantly improved cardiologists’ diagnostic accuracy and confidence in their interpretation approaching that of a standard 12‐lead ECG.

show abstract

Pharmacists detecting atrial fibrillation (PDAF) in primary care during the influenza vaccination season: a multisite, cross-sectional screening protocol

Cited by 12 publications

References 35 publications

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: A cross-sectional feasibility study

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: A cross-sectional feasibility study

Pharmacists detecting atrial fibrillation in general practice: a qualitative focus group study

Improved accuracy and confidence with multiple‐lead recordings from a single‐lead mobile electrocardiographic device

Contact Info

Product

Resources

About