Screening Education And Recognition in Community pHarmacies of Atrial Fibrillation to prevent stroke (SEARCH-AF)

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Atrial fibrillation (AF) is the most common heart arrhythmia affecting at least 240,000 Australians. Prevalence rises with age from approximately 1% of the whole population to 5% in those over 65 years. People with AF are up to seven times more likely to have a stroke than the general population, and AF related strokes are also likely to be more severe. In addition, one in every six strokes is AF related. Stroke is highly preventable in AF with the use of appropriate thromboprophylaxis. Therefore early identification and appropriate evidence based management of AF could lead to subsequent stroke prevention, significant reduction in the overall stroke burden and substantial savings to the health system. Our hypothesis is that a simple community pharmacy based screening program may be effective in detecting those with undiagnosed AF. The specific aims are to: 1. To identify the number of newly identified AF in people aged 65 years and over in a pharmacy setting. 2. Determine the feasibility of screening for AF using a pulse check and handheld singlelead electrocardiography (ECG) device in people aged 65 years and over. 3. Inform refinement of the intervention through the use of process measures with view to establishing a larger crosssectional study. 4. To increase the skills and knowledge of pharmacists regarding atrial fibrillation screening and management. We propose a crosssectional study offered in 10 community pharmacies in the districts surrounding the Concord Hospital. People aged 65 and over, attending community pharmacies will be invited to volunteer for the screening. The screening will consist of a pulse check, brief medical history including pharmacotherapy and screen of AF symptoms and an assessment with a handheld singlelead ECG device. The pharmacist will communicate the provisional diagnosis to the participants treating general practitioner (GP). For those participants suspected of having AF, the research team will contact the both the participant and their GP. We will invite the GP to refer their patient to Concord Hospital cardiology clinic for definitive diagnosis and standard cardiology care as appropriate. The primary outcome measure will be the number of newly identified atrial fibrillation in a community cohort aged 65 years and over. A process evaluation will also be undertaken to better appreciate factors that might influence sustainability beyond the trial setting.