OPPORTUNISTIC SCREENING FOR ATRIAL FIBRILLATION IN THE PHARMACIES

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Objective: Opportunistic screening outside medical clinics using easily available devices measuring blood pressure while simultaneously detecting irregular pulse could be potentially useful to identify patients with asymptomatic or unknown atrial fibrillation, thus reducing the burden of cardiovascular events, primarily systemic thromboembolism (NICE medical technology guidance 13, 2015). We performed a cross-sectional observational study aimed at evaluate the prevalence of atrial fibrillation and associated clinical conditions in adults older than 50 years living in the province of Verona. Design and method: All the citizens aged 50 or more were invited through an information campaign to reach their pharmacy to have their blood pressure and heart rate monitored with the Microlife Afib® device, which utilises an algorithm to calculate the irregularity of interval times between heartbeats and identify atrial fibrillation. Pharmacists collected for 6 months also anthropometric and demographic data of the participants, along with information concerning their personal history of cardiovascular disease and the use of anti-hypertensive and anti-thrombotic agents. All those who were positive to the screening for atrial fibrillation were referred to their medical doctor. Results: A total number of 3109 citizens took part in the study; 1605 of them were hypertensive, 297 diabetic and 372 obese. Positive for atrial fibrillation were 99 subjects (56 males). Only 44 of them had a previous diagnosis of atrial fibrillation and were receiving anticoagulation agents (77%) or aspirin (7%). Although subject positive to the screening were hypertensive, diabetic or obese in the same proportion of the negative ones, they had in a larger proportion a previous stroke (7% versus 2%, P < 0.01). Conclusions: Aim of our investigation was to obtain epidemiological data concerning the prevalence of atrial fibrillation, to identify previously non-detected cases and to promote consciousness in the population concerning the risk factors and the clinical consequences of atrial fibrillation. The results of our study indicate that opportunistic screening for atrial fibrillation in the pharmacies is feasible and allows identify a large number of subjects with silent, non-previously diagnosed atrial fibrillation, and is potentially useful in large-scale projects aimed at the prevention of cardiovascular mortality.

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