title: High prevalence of modifiable stroke risk factors identified in a pharmacy-based screening programme.
abstract: Population-based screening for atrial fibrillation (AF) is a promising public health strategy to prevent stroke. However, none of the published reports have evaluated comprehensive screening for additional stroke risk factors such as hypertension and diabetes in a pharmacy setting.
  
  
  
  The Program for the Identification of 'Actionable' Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy) screened individuals aged ≥65 years, attending community pharmacies in Canada, who were not receiving oral anticoagulation (OAC). Participants were screened for AF using a hand-held ECG device, had blood pressure (BP) measured, and diabetes risk estimated using the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) questionnaire. 'Actionable' AF was defined as unrecognised or undertreated AF. A 6-week follow-up visit with the family physician was suggested for participants with 'actionable' AF and a scheduled 3-month visit occurred at an AF clinic.
  
  
  
  During 6 months, 1145 participants were screened at 30 pharmacies. 'Actionable' AF was identified in 2.5% (95% CI 1.7 to 3.6; n=29); of these, 96% were newly diagnosed. Participants with 'actionable AF' had a mean age of 77.2±6.8 years, 58.6% were male and 93.1% had a CHA2DS2-VASc score ≥2. A BP>140/90 was found in 54.9% (616/1122) of participants and 44.4% (214/492) were found to be at high risk of diabetes. At 3 months, only 17% of participants were started on OAC, 50% had improved BP and 71% had confirmatory diabetes testing.
  
  
  
  Integrated stroke screening identifies a high prevalence of individuals who could benefit from stroke prevention therapies but must be coupled with a defined care pathway.
authors.affiliation: Division of Cardiology , University of Alberta , Edmonton, Alberta , Canada.
authors.forename: Roopinder K
authors.initials: RK
authors.lastname: Sandhu
authors.affiliation: Department of Family Medicine , McMaster University , Hamilton, Ontario , Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.affiliation: Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
authors.forename: Bishoy
authors.initials: B
authors.lastname: Deif
authors.affiliation: Division of Cardiology , University of Alberta , Edmonton, Alberta , Canada.
authors.forename: Walid
authors.initials: W
authors.lastname: Barake
authors.affiliation: Department of Family Medicine , McMaster University , Hamilton, Ontario , Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Grinvalds
authors.affiliation: Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
authors.forename: Ting
authors.initials: T
authors.lastname: Lim
authors.affiliation: Division of Cardiology , University of Calgary , Calgary, Alberta , Canada.
authors.forename: F Russell
authors.initials: FR
authors.lastname: Quinn
authors.affiliation: Division of Neurology , University of Toronto , Toronto, Ontario , Canada.
authors.forename: David
authors.initials: D
authors.lastname: Gladstone
authors.affiliation: Division of Internal Medicine , University Hospital , Basel , Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Conen
authors.affiliation: Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
authors.affiliation: Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Healey