Project IMPACT Cardiovascular Health+: Pharmacy services for better cardiovascular health

BACKGROUND: Atrial fibrillation (Afib) is a leading cause of stroke and is frequently underdiagnosed. Pharmacists are often the most accessible provider and have the expertise and training to screen for and impact cardiovascular risk and address social determinants of health (SDOH). OBJECTIVES: The aims of this research were to create an Afib screening access point in the community, to increase access to medication therapy management (MTM) for cardiovascular risk reduction, and to address SDOH. PRACTICE DESCRIPTION: Forty community pharmacies in 20 states participated in this project. Participating patients presented to a pharmacist for usual and customary care at a participating pharmacy, met all inclusion criteria, and provided informed consent. PRACTICE INNOVATION: Pharmacists offered the Cardiovascular Health+ service, which included (1) Screening for SDOH, (2) Completion of a validated Stroke Risk Assessment, (3) Point-of-care electrocardiogram (EKG) testing, and (4) Assessment of the need for MTM services. EVALUATION METHODS: Descriptive statistics were used to analyze patient demographics as well as frequencies and relative frequencies of visit components. EKG and stroke risk assessment findings were further analyzed for trends related to demographic factors. Logistic regression was used to identify correlations various factors and outcomes of interest. RESULTS: 2,105 participants were enrolled. 4,037 EKG assessments were performed with Afib accounting for 173 (23.6%) of abnormal findings. Afib readings were present in 4.7% of participants compared to 1.5% in the general U.S population (p < 0.001). Fifty-five patients were referred to other providers based on the results of the stroke risk assessment, EKG, or both. 4,186 responses were collected for SDOH screening and 276 patients (13%) were identified with medication SDOH needs. The survey of participating pharmacies identified common barriers to sustainability including fair compensation for pharmacist services. CONCLUSION: Community pharmacists have a vital role and demonstrated that they can serve as an additional access point in the identification of Afib and other abnormal rhythms, cardiovascular risk, and SDOH factors. This research shows the significant Afib identification rates that can be accomplished in community pharmacies and presents a solution for scaling the delivery of accessible patient care services that reduce cardiovascular risk.