Patient comment in June 2017:
Mrs Shushilaben B Patel: I was feeling unwell and getting up several times through the night. My pharmacist measured my blood pressure and carried out an ECG. My heart rate was 46 and he said that my heart rhythm needed checking. I was seen by the GP within two hours and admitted to hospital same day. I believe pharmacists can save lives by routinely providing heart checks in community pharmacies’.
Detecting Atrial Fibrillation through community pharmacy
From 2nd June – 15th July 2014, the innovative North East London Local Pharmaceutical Committee conducted testing for atrial fibrillation (AF) within their local community.
Atrial Fibrillation (AF) is the most common cardiac arrhythmia with an overall prevalence of approximately 5%, rising from 1% in the age group 55-59 years to 18% in those aged 85 years and above. Individuals with AF have a 5-fold increased risk of stroke, and one in five of all strokes is attributed to this arrhythmia. In addition, strokes in association with AF are often fatal, and those patients who survive are left more disabled by their stroke and more likely to suffer a recurrence than patients with other causes of stroke. Heart rhythm disorders are surprisingly common, and they account for high costs to the NHS. Since the early detection of AF followed by appropriate treatment can reduce the chance of stroke by two-thirds the usefulness of testing for atrial fibrillation can hardly be questioned. Certainly not if one considers that the AF prevalence is on the increase and that AF-related death rates increased almost three-fold between 1995 and 2010 in England.
Currently, there are innovative tools on the market, making it easy to test for AF. In the pharmacies of North East London LPC two such devices were used: The Microlife WatchBP home A, a NICE recommended blood pressure monitor that can detect AF during blood pressure measurement and the Alivecor ECG. Although the results as presented below are robust the testing has undoubtedly led to newly detected AF and, therefore, indirectly to the prevention of strokes.
WatchBP Home A
In total 57 Pharmacies linked to www.nellpc.org.uk participated in this project. Together, they tested 1800 people with a mean age of 60 years for the presence of AF. In 388 subjects (22%) the AFIB symbol appeared during blood pressure measurement with the WatchBP Home A suggesting the presence of AF. From 50 patients (3%) it was already known by their GP that AF was present. The remaining 338 were referred to their GP for further investigation. From previous clinical research with the WatchBP Home A it may be expected that approximately half of them have atrial fibrillation.
ECGs reported by AliveInsights™ provider, Technomed Telemedicine
We can be confident that lives were saved, and strokes prevented in the 2,800 that had their heart rhythm analysed since the results are as follows:
- Green, stable rhythm no follow-up suggested: 2573
- Amber, needs review, recommend follow-up with a Doctor within 24 hours: 200
- Red, Serious, recommend URGENT follow-up: 2
Overall, community pharmacy study reported that there were cases with undetected low blood pressure, high blood pressure, people on anti-hypertensives with low blood pressure. Also, there were cases of people with arrhythmias, bradycardia and tachycardia. This study showed that community pharmacy is a trusted setting for providing cardio checks as well as traditional health checks.
Since 1st September, in partnership with CareCity, Waltham Forest CCG is now testing a direct referral to a cardiology team at Whipps Cross Hospital in NE London. The pilot is expected to run for six months.
For further information please contact Hemant Patel, Secretary of NE London Local Pharmaceutical Committee at firstname.lastname@example.org