Blood Pressure Monitors in Screening of Atrial Fibrillation by Community Pharmacists: Data from a Nationwide Awareness Campaign

Studies have demonstrated that community pharmacies can feasibly conduct opportunistic screening for atrial fibrillation (AF) as part of an awareness campaign. This observational study aims to analyse how often Slovak pharmacies detect suspected AF using readily available measures.

We conducted anonymised data collection in 212 pharmacies between 2017 and 2020 as part of a nationwide cardiovascular risk awareness campaign and performed routine blood pressure (BP) measurements in adult visitors using an oscillometric BP monitor with an AF detection algorithm. We retrospectively evaluated pharmacy records for the presence or absence of suspected AF (sAF + or sAF-), BP measures, resting heart rate (RHR), and the presence or absence (+ or -) of pharmacotherapy (antihypertensives; AH and/or anticoagulants; ACo), and calculated pulse pressure (PP).

The overall occurrence of sAF was 3.8% in the cohort. We observed significantly higher values of all BP measures in the sAF+ group than in the sAF- group, with PP as the most consistent and the strongest observational variable of sAF among all hemodynamic variables assessed. Pharmacological treatment was also associated with a significantly increased risk of sAF, with a more pronounced (8.65-fold) risk in patients on a combination of therapies, followed by those treated with anticoagulants alone (4.21 fold) and antihypertensives alone (2.10-fold). RHR was not significantly different between sAF + and sAF-, but it was a significant determinant of sAF detection rate, as we documented a non-linear relationship between RHR and sAF. Pharmacological treatment was strongly associated with the presence of suspected AF when compared with untreated individuals. The strongest association was in patients receiving both therapies (OR = 8.65, 95% CI 5.83–12.82, p < 0.0001), followed by AH-/ACo+ (OR = 4.21, 95% CI 1.62–10.95, p < 0.01) and AH+/ACo- (OR = 2.10, 95% CI 1.37–3.23, p < 0.001).

Opportunistic screening revealed a strong association of sAF with PP and with combination of ACo and AH within the provision of routine preventive services in a community pharmacy setting. Patients with sAF+ used anticoagulants to a marked extent, and the analysis documented a J-shaped association between sAF and RHR.