Background and introduction: The prevalence of atrial fibrillation (AF) in the UK is around 2%, affecting more than 10% of people aged over 80 years. AF is associated with a high risk of stroke. Early identification and treatment reduces this risk.1 The Capture AF service is an innovative service allowing seamless identification, treatment and management of patients with AF. It involves community pharmacists recording the patient’s ECG with a Kardia monitor and directly referring patients with undiagnosed or sub-optimally treated AF to the Arrhythmia Care Team at Harefield Hospital.
Aims and objectives: To evaluate the impact of the Capture AF service.
Method: 28 community pharmacists received intensive training on AF, how to record an ECG using a Kardia monitor and documenting the consultation on a PharmOutcomes (national pharmacy database) referral form. Patients were automatically referred by the community pharmacist to the arrhythmia clinic at Harefield Hospital if they had a possible new AF diagnosis, previous AF diagnosis and not anticoagulated, anticoagulated but experiencing side effects or compliance issues or a high AF symptom burden. Patients initiated on anticoagulation were referred to the community pharmacist via the New Medicines Service (NMS)2 for adherence monitoring.
Results: During a pilot (May–October 2016) and final phase
(May 2018–March 2019), 1,682 patients were enrolled. (NMS referral – final phase only).
Of the 1,682 enrolled, 90 were seen in clinic. 18 patients were newly diagnosed with AF, 8 patients with previous AF were started on anticoagulation. 31 patients had their medications optimised including dose adjustment of DOAC, cessation of antiplatelet, titration of rate control medication and conversion from warfarin to DOAC.
Discussion and conclusion: The results demonstrate that the Capture AF service is a robust multi-disciplinary pathway for detection, protection and perfection of AF. The direct-referral pathway ensures that patients are reviewed by a specialist team and receive optimal treatment and management. Referral back to the community pharmacist via the NMS enhances adherence to anticoagulation.
References
1. National Institute for Health and Care Excellence (UK). Atrial fibrillation: the management of atrial fibrillation. NICE Clinical Guidelines,
No. 180. 2014. Available at: www.ncbi.nlm.nih.gov/books/NBK248059 (accessed 13 August 2019).
2. Elliott R, Boyd M, Waring J, et al. Department of Health Policy Research Programme Project ‘Understanding and appraising the new medicines service in the NHS in England (020/0124)’. Available at: www.nottingham.ac.uk/~pazmjb/nms/downloads/report/files/assets/
basic-html/index.html#1 (accessed 13 August 2019).
3. Alderwick, H, Dixon, J. The NHS long term plan. BMJ. 2019;364:I84.
Ethics approval was not required as this is externally funded research project regarding provision of a new service.
