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The involvement of pharmacies in the screening of undiagnosed atrial fibrillation

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Abstract

Early identification of atrial fibrillation (AF) is now a priority in cardiovascular prevention because AF is common although often asymptomatic, and is associated with poor outcomes that are highly preventable with appropriate medical treatment. In Italy, AF prevalence among subjects aged ≥65 years ranges from 5 to 6% in observational studies based on the diagnosis recorded by general practitioners to 10–11% in studies where ECG screening is routinely offered. It is thus evident that a large number of subjects are not detected by conventional approach, and new strategies are required to increase early detection of AF. In particular, the changing position of pharmacies in the health system should be considered. Because of its small geographical size, insular nature and captive population, the Isle of Elba represents an ideal setting to test new strategies for stroke reduction. The Elba-FA project was thus designed to determine the feasibility and impact of the combined involvement of pharmacies and general practices to screen undiagnosed AF, with the ultimate aim of reducing the burden of stroke and arterial thromboembolism. The findings obtained with this approach might have broad implications for cardiovascular prevention at the general population level in Italy.

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References

  1. Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146(12):857–867

    Article  PubMed  Google Scholar 

  2. Di Minno MN, Russolillo A, Di Minno A, Camera M, Parolari A, Tremoli E (2013) Direct anticoagulant drugs to overcome limitations of vitamin K antagonists. A critical appraisal of data in atrial fibrillation patients. Expert Opin Emerg Drugs 18(1):9–23. doi:10.1517/14728214.2013.777427

    Article  PubMed  Google Scholar 

  3. Prisco D, Ageno W, Becattini C, D’Angelo A, Davi G, De Cristofaro R, Dentali F, Di Minno G, Falanga A, Gussoni G, Masotti L, Palareti G, Pignatelli P, Santi RM, Santilli F, Silingardi M, Tufano A, Violi F (2017) Italian intersociety consensus on DOAC use in internal medicine. Intern Emerg Med. doi:10.1007/s11739-017-1628-6

    Google Scholar 

  4. Riva N, Ageno W (2015) Direct oral anticoagulants in atrial fibrillation: can data from randomized clinical trials be safely transferred to the general population? Yes. Intern Emerg Med 10(6):641–645. doi:10.1007/s11739-015-1277-6

    Article  PubMed  Google Scholar 

  5. Coleman CI, Antz M (2017) Real-world evidence with apixaban for stroke prevention in patients with nonvalvular atrial fibrillation in Germany: a retrospective study (REASSESS). Intern Emerg Med. doi:10.1007/s11739-017-1624-x

    Google Scholar 

  6. Olesen JB, Sorensen R, Hansen ML, Lamberts M, Weeke P, Mikkelsen AP, Kober L, Gislason GH, Torp-Pedersen C, Fosbol EL (2015) Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients: Danish nationwide descriptive data 2011–2013. Europace 17(2):187–193. doi:10.1093/europace/euu225

    Article  PubMed  Google Scholar 

  7. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37(38):2893–2962. doi:10.1093/eurheartj/ehw210

    Article  PubMed  Google Scholar 

  8. Sposato LA, Cipriano LE, Saposnik G, Ruiz Vargas E, Riccio PM, Hachinski V (2015) Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 14(4):377–387. doi:10.1016/s1474-4422(15)70027-x

    Article  PubMed  Google Scholar 

  9. Salvatori V, Becattini C, Laureti S, Baglioni G, Germini F, Grilli P, Guercini F, Filippucci E, Agnelli G (2015) Holter monitoring to detect silent atrial fibrillation in high-risk subjects: the Perugia General Practitioner Study. Intern Emerg Med 10(5):595–601. doi:10.1007/s11739-015-1241-5

    Article  PubMed  Google Scholar 

  10. Friberg L, Hammar N, Rosenqvist M (2010) Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation. Eur Heart J 31(8):967–975. doi:10.1093/eurheartj/ehn599

    Article  PubMed  Google Scholar 

  11. Huisman MV, Ma CS, Diener HC, Dubner SJ, Halperin JL, Rothman KJ, Teutsch C, Schoof N, Kleine E, Bartels DB, Lip GYH, G-A Investigators (2016) Antithrombotic therapy use in patients with atrial fibrillation before the era of non-vitamin K antagonist oral anticoagulants: the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) Phase I cohort. Europace 18(9):1308–1318. doi:10.1093/europace/euw073

    Article  PubMed  PubMed Central  Google Scholar 

  12. Savelieva I, Camm AJ (2000) Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J Interv Card Electrophysiol 4(2):369–382

    Article  CAS  PubMed  Google Scholar 

  13. Dilaveris PE, Kennedy HL (2017) Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol. doi:10.1002/clc.22667

    PubMed  Google Scholar 

  14. Lip GY, Tse HF, Lane DA (2012) Atrial fibrillation. Lancet 379(9816):648–661. doi:10.1016/S0140-6736(11)61514-6

    Article  PubMed  Google Scholar 

  15. Lowres N, Neubeck L, Redfern J, Freedman SB (2013) Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost 110(2):213–222. doi:10.1160/th13-02-0165

    Article  CAS  PubMed  Google Scholar 

  16. Piccinocchi G, Laringe M, Guillaro B, Arpino G, Piccinocchi R, Nigro G, Calabro P (2012) Diagnosis and management of atrial fibrillation by primary care physicians in Italy: a retrospective, observational analysis. Clin Drug Investig 32(11):771–777. doi:10.1007/s40261-012-0005-5

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zoni-Berisso M, Filippi A, Landolina M, Brignoli O, D’Ambrosio G, Maglia G, Grimaldi M, Ermini G (2013) Frequency, patient characteristics, treatment strategies, and resource usage of atrial fibrillation (from the Italian Survey of Atrial Fibrillation Management [ISAF] Study). Am J Cardiol 111(5):705–711. doi:10.1016/j.amjcard.2012.11.026

    Article  PubMed  Google Scholar 

  18. Scalvini S, Piepoli M, Zanelli E, Volterrani M, Giordano A, Glisenti F (2005) Incidence of atrial fibrillation in an Italian population followed by their GPs through a telecardiology service. Int J Cardiol 98(2):215–220. doi:10.1016/j.ijcard.2003.12.005

    Article  PubMed  Google Scholar 

  19. Bilato C, Corti MC, Baggio G, Rampazzo D, Cutolo A, Iliceto S, Crepaldi G (2009) Prevalence, functional impact, and mortality of atrial fibrillation in an older Italian population (from the Pro.V.A. study). Am J Cardiol 104(8):1092–1097. doi:10.1016/j.amjcard.2009.05.058

    Article  PubMed  Google Scholar 

  20. Dunn SP, Birtcher KK, Beavers CJ, Baker WL, Brouse SD, Page RL 2nd, Bittner V, Walsh MN (2015) The role of the clinical pharmacist in the care of patients with cardiovascular disease. J Am Coll Cardiol 66(19):2129–2139. doi:10.1016/j.jacc.2015.09.025

    Article  PubMed  Google Scholar 

  21. Carter BL (2016) Evolution of clinical pharmacy in the USA and future directions for patient care. Drugs Aging 33(3):169–177. doi:10.1007/s40266-016-0349-2

    Article  PubMed  PubMed Central  Google Scholar 

  22. Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G (2011) Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med 171(16):1441–1453. doi:10.1001/archinternmed.2011.399

    Article  CAS  PubMed  Google Scholar 

  23. Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffe P, Burnier M, Burnand B, Paradis G (2014) Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc 3(2):e000718. doi:10.1161/JAHA.113.000718

    Article  PubMed  PubMed Central  Google Scholar 

  24. Twigg MJ, Wright DJ, Thornley T, Haynes L (2015) Community pharmacy type 2 diabetes risk assessment: demographics and risk results. Int J Pharm Pract 23(1):80–82. doi:10.1111/ijpp.12139

    Article  PubMed  Google Scholar 

  25. Cooney D, Moon H, Liu Y, Miller RT, Perzynski A, Watts B, Drawz PE (2015) A pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trial. BMC Nephrol 16:56. doi:10.1186/s12882-015-0052-2

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lowres N, Neubeck L, Salkeld G, Krass I, McLachlan AJ, Redfern J, Bennett AA, Briffa T, Bauman A, Martinez C, Wallenhorst C, Lau JK, Brieger DB, Sy RW, Freedman SB (2014) Feasibility and cost-effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb Haemost 111(6):1167–1176. doi:10.1160/th14-03-0231

    Article  CAS  PubMed  Google Scholar 

  27. Sandhu RK, Dolovich L, Deif B, Barake W, Agarwal G, Grinvalds A, Lim T, Quinn FR, Gladstone D, Conen D, Connolly SJ, Healey JS (2016) High prevalence of modifiable stroke risk factors identified in a pharmacy-based screening programme. Open Heart 3(2):e000515. doi:10.1136/openhrt-2016-000515

    Article  PubMed  PubMed Central  Google Scholar 

  28. Doliwa PS, Frykman V, Rosenqvist M (2009) Short-term ECG for out of hospital detection of silent atrial fibrillation episodes. Scand Cardiovasc J 43(3):163–168. doi:10.1080/14017430802593435

    Article  PubMed  Google Scholar 

  29. Kaleschke G, Hoffmann B, Drewitz I, Steinbeck G, Naebauer M, Goette A, Breithardt G, Kirchhof P (2009) Prospective, multicentre validation of a simple, patient-operated electrocardiographic system for the detection of arrhythmias and electrocardiographic changes. Europace 11(10):1362–1368. doi:10.1093/europace/eup262

    Article  PubMed  Google Scholar 

  30. Claes N, Van Laethem C, Goethals M, Goethals P, Mairesse G, Schwagten B, Nuyens D, Schrooten W, Vijgen J (2012) Prevalence of atrial fibrillation in adults participating in a large-scale voluntary screening programme in Belgium. Acta Cardiol 67(3):273–278. doi:10.2143/ac.67.3.2160714

    Article  PubMed  Google Scholar 

  31. Samol A, Masin M, Gellner R, Otte B, Pavenstadt HJ, Ringelstein EB, Reinecke H, Waltenberger J, Kirchhof P (2013) Prevalence of unknown atrial fibrillation in patients with risk factors. Europace 15(5):657–662. doi:10.1093/europace/eus366

    Article  PubMed  Google Scholar 

  32. Wiesel J, Fitzig L, Herschman Y, Messineo FC (2009) Detection of atrial fibrillation using a modified microlife blood pressure monitor. Am J Hypertens 22(8):848–852. doi:10.1038/ajh.2009.98

    Article  PubMed  Google Scholar 

  33. Costantino G, Podda GM, Falsetti L, Iannone P, Lages A, Marra AM, Masala M, Reiakvam OM, Savva F, Schovanek J, van Bree S, da Silva Chora IJ, Privitera G, Ragozzino S, von Rotz M, Woittiez L, Davidson C, Montano N (2016) Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal. Intern Emerg Med. doi:10.1007/s11739-016-1580-x

    Google Scholar 

  34. Cooke G, Doust J, Sanders S (2006) Is pulse palpation helpful in detecting atrial fibrillation? A systematic review. J Fam Pract 55(2):130–134

    PubMed  Google Scholar 

  35. Tieleman RG, Plantinga Y, Rinkes D, Bartels GL, Posma JL, Cator R, Hofman C, Houben RP (2014) Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation. Europace 16(9):1291–1295. doi:10.1093/europace/euu057

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Vaes B, Stalpaert S, Tavernier K, Thaels B, Lapeire D, Mullens W, Degryse J (2014) The diagnostic accuracy of the MyDiagnostick to detect atrial fibrillation in primary care. BMC Fam Pract 15:113. doi:10.1186/1471-2296-15-113

    Article  PubMed  PubMed Central  Google Scholar 

  37. Battipaglia MdI, Gilbert BK, Hogarth Md Ph DA, Tayebjee Md MH (2016) Screening for atrial fibrillation in the community using a novel ECG recorder. J Atr Fibrillation 9(2):1433. doi:10.4022/jafib.1433

    PubMed  PubMed Central  Google Scholar 

  38. Jacobs MS, Kaasenbrood F, Postma MJ, van Hulst M, Tieleman RG (2016) Cost-effectiveness of screening for atrial fibrillation in primary care with a handheld, single-lead electrocardiogram device in the Netherlands. Europace. doi:10.1093/europace/euw285

    PubMed  Google Scholar 

  39. Kaasenbrood F, Hollander M, Rutten FH, Gerhards LJ, Hoes AW, Tieleman RG (2016) Yield of screening for atrial fibrillation in primary care with a hand-held, single-lead electrocardiogram device during influenza vaccination. Europace 18(10):1514–1520. doi:10.1093/europace/euv426

    Article  PubMed  PubMed Central  Google Scholar 

  40. Delamater PL, Messina JP, Shortridge AM, Grady SC (2012) Measuring geographic access to health care: raster and network-based methods. Int J Health Geogr 11(1):15. doi:10.1186/1476-072X-11-15

    Article  PubMed  PubMed Central  Google Scholar 

  41. Joseph AE, Phillips DR (1984) Accessibility and utilization: geographical perspectives on health care delivery. Harper & Row Ltd, London

    Google Scholar 

  42. Sciacqua A, Perticone M, Tripepi G, Tassone EJ, Cimellaro A, Mazzaferro D, Sesti G, Perticone F (2015) CHADS2 and CHA2DS2-VASc scores are independently associated with incident atrial fibrillation: the Catanzaro Atrial Fibrillation Project. Intern Emerg Med 10(7):815–821. doi:10.1007/s11739-015-1243-3

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Medicina Sperimentale e Clinica, Universita’ degli Studi di Firenze, Largo Brambilla 3, 50134, Florence, Italy

    Pietro Amedeo Modesti, Andrea Colella & Maria Boddi

  2. Direttore di Zona Distretto Elba, ATNO, Portoferraio, Livorno, Italy

    Gianni Donigaglia

  3. Unità Operativa di Medicina dell’Ospedale di Portoferraio, Livorno, Italy

    Plinio Fabiani & Nicola Mumoli

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  1. Pietro Amedeo Modesti
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  2. Gianni Donigaglia
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  3. Plinio Fabiani
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  4. Nicola Mumoli
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  5. Andrea Colella
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Correspondence to Pietro Amedeo Modesti.

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Modesti, P.A., Donigaglia, G., Fabiani, P. et al. The involvement of pharmacies in the screening of undiagnosed atrial fibrillation. Intern Emerg Med 12, 1081–1086 (2017). https://doi.org/10.1007/s11739-017-1752-3

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