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Atrial fibrillation screening in North East London pharmacies

From 2nd June to the 15th July 2014, the innovative North East London LPC conducted a screening 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 1. Individuals with AF have a 5-fold increased risk of stroke, and one in five of all strokes is attributed to this arrhythmia 2. 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 3.

AF generally starts with short episodes that spontaneously disappear, so-called paroxysmal AF. This intermittent nature, together with an estimated 20% of all AF patients having no symptoms, makes it difficult to detect AF at an early stage. Since Paroxysmal AF carries the same stroke risk as persistent or permanent AF 4, irrespective of the presence of symptoms 5 AF regularly is first detected at the time of a stroke.

Since the early detection of AF followed by appropriate treatment can reduce the chance of stroke by two-thirds 6 the usefulness of screening 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 7.

Currently, there are innovative tools on the market, making it easy to screen 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 8 and the Alivecor an Iphone ECG. Although the results as presented below are robust the screening 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 screened 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 9.

 

ECGs reported by AliveInsights™ provider, Technomed Telemedicine:

From the 2,800 that had their heart rhythm analysed with the Alivecor 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

 

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References

  1. Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949-53.
  2. European Heart Rhythm A, European Association for Cardio-Thoracic S, Camm AJ, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010;12:1360-420.
  3. Steger C, Pratter A, Martinek-Bregel M, et al. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry. Eur Heart J 2004;25:1734-40.
  4. Friberg L, Hammar N, Rosenqvist M. Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation. Eur Heart J 2010;31:967-75.
  5. Page RL, Tilsch TW, Connolly SJ, et al. Asymptomatic or “silent” atrial fibrillation: frequency in untreated patients and patients receiving azimilide. Circulation 2003;107:1141-5.
  6. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857-67.
  7. Duncan ME, Pitcher A, Goldacre MJ. Atrial fibrillation as a cause of death increased steeply in England between 1995 and 2010. Europace 2013.
  8. NICE. WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension. http://guidanceniceorguk/MTG13 2013.
  9. Kearley K, Selwood M, Van den Bruel A, et al. Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors. BMJ open 2014;4:e004565.

 

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