22 December 2016
Trust senior pharmacists Zainab Khanbhai and Sally Manning were awarded a research grant in 2015 from The Health Foundation, innovating for improvement funding stream, to improve identification and treatment of patients with atrial fibrillation (AF). Zainab subsequently led the pilot study, which involved community pharmacists supporting diagnosis and treatment of these patients.
The project was included as a case study in the Royal Pharmaceutical Society (RPS) report ‘Frontline pharmacists: Making a difference for people with long-term conditions’, and was commended by the RPS for its role in improving the care of patients with a long-term condition such as AF. The report was launched recently at the House of Commons and Zainab was invited to the event.
AF is the most common sustained atrial arrhythmia (disturbance in cardiac rhythm), and is characterised by a rapid, irregular heartbeat. It increases the risk of stroke, morbidity and mortality, and reduces quality of life - so early detection is crucial.
Community pharmacists who currently provide face-to face medicines-use reviews (MURs) to patients are ideally placed to diagnose AF and can also identify where treatment can be improved. As part of the pilot study, community pharmacists carried out enhanced MURs in patients at risk of AF, using a single hand-held ECG monitor to detect the patient’s heart rate and rhythm. They also used questionnaires to evaluate the risk of stroke and bleeding and assess quality of life.
Patients newly identified with AF, or who have previously diagnosed AF but are not taking blood-thinners, are then directly referred to the Arrhythmia Care Team (ACT) at Harefield Hospital. This is a new and active role for pharmacists as they are directly contributing to early identification of AF in patients who might not show any signs of it, and optimising treatment for patients with previously diagnosed AF.
The data collection phase is now complete and follow-up is in progress, with preliminary results extremely promising. Through working across primary and secondary care interfaces to streamline referrals, the project has led to earlier treatment and care of AF patients.
Zainab is looking forward to sharing the final results of the study, due to be published early next year, and commented: “Our study demonstrates that improved diagnosis of AF in a multi-disciplinary and collaborative way across the primary/secondary care interface utilising innovative technology is possible and requires further exploration.”