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Timely detection and treatment of AF is amongst the Government’s cardiovascular priorities. Several initiatives have demonstrated the potential of AF detection using single-lead electrocardiogram (SLECG) technology in primary care settings, such as general practitioners’ (GP) surgeries. Unfortunately, some AF patients, including those from ethnic minorities, may not routinely engage with main-stream healthcare and may go undetected. Compared to White British, South Asians have a higher prevalence of cardiovascular risk factors, however fewer are diagnosed with AF. This study aimed to ascertain the feasibility of opportunistic AF screening within a South Asian community delivered by supervised pharmacy undergraduates using SL-ECG devices.

Atrial fibrillation (AF) affects up to 10% of ≥ 65-year-olds and contributes to one in four ischaemic strokes, costing the UK economy > £1 billion each year. Clinical pharmacists' (CPs) integration into general practitioner (GP) surgeries and care homes offers an opportunity to facilitate AF screening. This thesis aimed to explore the role of primary care CPs in AF screening excluding the community pharmacy environment. The 'Pharmacists Detecting Atrial Fibrillation' (PDAF) study recruited 604 participants aged ≥ 65 years in GP surgeries over two influenza vaccination seasons. CP-led AF screening, using pulse palpation and single-lead electrocardiogram (SLECG) devices, identified 'new' AF in 1.3% of individuals who qualified for oral anticoagulant (OAC) therapy. This intervention had a 72% probability of being cost-effective, particularly with SLECG devices rather than pulse palpation which produced 5.2% more false positive AF diagnoses. Patients, CPs and practice staff praised the convenience of screening and emphasised the role of CPs in reassuring patients. Their vision of AF screening involved a personalised cardiovascular disease (CVD) service targeting at-risk groups. The PDAF study therefore extended into care homes. A further 53 participants were recruited, and 9.6% were found to have undiagnosed AF qualifying for OAC therapy. Screening using SLECG devices in this setting was 89% cost-effective but suffered from under-recruitment, low follow-up rates and poor diagnostic accuracy. Another initiative used SLECG devices to deliver AF screening within a South Asian community setting. Pharmacy undergraduates of matching heritage screened 572 participants over nine days under CP supervision. Out of ≥ 65s, 1.5% had a newly detected AF and could be considered for OAC therapy. The intervention had a 95% probability of being cost-effective and was viewed as a valuable cause for local community, although its future implementation could be compromised by ineffective ref

Atrial fibrillation (AF) affects up to 10% of ≥ 65-year-olds and contributes to one in four ischaemic strokes, costing the UK economy > £1 billion each year. Clinical pharmacists' (CPs) integration into general practitioner (GP) surgeries and care homes offers an opportunity to facilitate AF screening. This thesis aimed to explore the role of primary care CPs in AF screening excluding the community pharmacy environment. The 'Pharmacists Detecting Atrial Fibrillation' (PDAF) study recruited 604 participants aged ≥ 65 years in GP surgeries over two influenza vaccination seasons. CP-led AF screening, using pulse palpation and single-lead electrocardiogram (SLECG) devices, identified 'new' AF in 1.3% of individuals who qualified for oral anticoagulant (OAC) therapy. This intervention had a 72% probability of being cost-effective, particularly with SLECG devices rather than pulse palpation which produced 5.2% more false positive AF diagnoses. Patients, CPs and practice staff praised the convenience of screening and emphasised the role of CPs in reassuring patients. Their vision of AF screening involved a personalised cardiovascular disease (CVD) service targeting at-risk groups. The PDAF study therefore extended into care homes. A further 53 participants were recruited, and 9.6% were found to have undiagnosed AF qualifying for OAC therapy. Screening using SLECG devices in this setting was 89% cost-effective but suffered from under-recruitment, low follow-up rates and poor diagnostic accuracy. Another initiative used SLECG devices to deliver AF screening within a South Asian community setting. Pharmacy undergraduates of matching heritage screened 572 participants over nine days under CP supervision. Out of ≥ 65s, 1.5% had a newly detected AF and could be considered for OAC therapy. The intervention had a 95% probability of being cost-effective and was viewed as a valuable cause for local community, although its future implementation could be compromised by ineffective ref

Background: The ‘Clinical Pharmacists in General Practice’ (CPGP) pilot provided a template for general practice pharmacy professionals’ (GPPPs) roles encouraging NHS England to fund >2000 practice‐based pharmacists. However, many GPPPs work outside the CPGP initiative and little is known about the services they provide. Objectives: To explore services provided by all UK GPPPs (pharmacists/pharmacy technicians), including the types of services, perceived benefits and barriers to role development. Methods: A 26‐item electronic questionnaire was developed using SurveyMonkey and piloted during cognitive interviews. A cross‐sectional survey was conducted via social media, primary care organisations and emails to CPGP pilot sites between November 2018 and March 2019. Three reminders were sent 1 week apart. Key findings: Ninety‐one complete responses were received (81 pharmacists; 10 technicians). Over 80% of pharmacists provided clinical services, such as medication reviews or management of long‐term conditions. More pharmacists within CPGP pilot managed repeat prescribing requests (P = 0.035). Technicians took responsibility for primarily non‐clinical roles, including commissioning or safety alerts/drug recalls. A third of GPPPs wished to develop care home services. Perceived benefits of GPPPs’ services included improved utilisation/development of professional skills, identifying medicines‐related issues and reduction in medication waste. Respondents were satisfied with professional relationships but reported workload issues, limited patient awareness of their roles and restricted opportunities to contribute to service development, which was associated with unsatisfactory support/mentorship (P < 0.001). Conclusion: General practice pharmacy professionals deliver clinical and non‐clinical services which may benefit patients, general practice and the healthcare system. General practices and national organisations should provide GPPPs with tailored support and exploit the

Reducing AF-related stroke risk is both clinically and economically important, with AF-related illness costing the NHS over £2 billion per annum. Despite this, there is no national screening programme for AF. Growing medical consensus backed by public health policy, agrees that there is an unmet need to improve diagnosis and that primary care is an appropriate setting. This model is likely to be convenient for patients and cost effective, but with the current shortage of GPs and nurses, and increasing GP workloads, it is unlikely to succeed. Huge investment by NHS England to introduce new work role models to GP practices, could mean, by 2021, that over 34 million patients will have access to the expertise of a clinical pharmacist, making clinical pharmacists a viable option for such screening initiatives. AIM: To determine whether clinical pharmacists based within GP practices, were able to accurately and effectively screen and diagnose patients for AF, using pulse palpation and a single-lead ECG device (AliveCor Kardia Mobile®) during the influenza vaccination season.

Introduction: Atrial fibrillation (AF) affects >6% of people aged 65 years or older. Left undetected and untreated, patients may develop significant cardiovascular complications and have a fivefold increased risk of suffering a stroke. For 40% of all sufferers, AF can be asymptomatic. Every year in the UK, £2.2 billion is spent on AF-related strokes, so there is an urgent need to improve early detection of AF. This study aims to determine the feasibility of using trained clinical pharmacists based in general practices, to screen for AF, using pulse palpation and a single-lead ECG device on participants aged 65 years or older, attending influenza vaccination clinics. Methods and analysis: Seven clinical pharmacists will be trained by a cardiologist to pulse palpate and record single-lead ECGs using the AliveCor Kardia Mobile device. Quantitative analysis will assess the accuracy and ability of the clinical pharmacist to identify pulse irregularities using pulse palpation and to record and interpret a singlelead ECG. The level of agreement of pulse irregularities detected by pulse palpation will be compared with those detected by the single-lead ECG device, as will the level of agreement between the cardiologist and the device’s interpretation of the ECG. The proportion of people identified with AF (confirmed by the cardiologist) will be determined. Additional demographic data will be obtained from all participants through a questionnaire. Qualitative data will be captured from the participants, from the clinical pharmacists and from the general practitioners and practice staff to determine their views on this method of AF screening. We aim to recruit 600 participants across general practices within Kent. Ethics and dissemination: This protocol was approved by the London–Riverside Research Ethics committee. The findings of this study will be disseminated through forums including, but not limited to, peer-reviewed journals, national and international conferences.