Screening for Undiagnosed Atrial Fibrillation in Community Pharmacies using mobile electrocardiogram technology: A Quasi-Experimental Cross- Sectional Study (PREVENIM ICTUS)

Screening for Undiagnosed Atrial Fibrillation in Community Pharmacies using mobile electrocardiogram technology: A Quasi-Experimental Cross- Sectional Study (PREVENIM ICTUS) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Screening for Undiagnosed Atrial Fibrillation in Community Pharmacies using mobile electrocardiogram technology: A Quasi-Experimental Cross- Sectional Study (PREVENIM ICTUS) Óscar García Agudo, Ricardo Fuertes González, María García Gil, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7262408/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Jan, 2026 Read the published version in BMC Primary Care → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Atrial fibrillation (AF) is a common, often silent, arrhythmia that markedly increases stroke risk yet remains undiagnosed in many high-risk adults. Mobile electrocardiogram technology in community pharmacies has detected 1–5% new AF internationally, but real-world pharmacist-led data in Southern Europe are scarce. Our study screened adults ≥55 years with cardiovascular risk factors in Spanish pharmacies to determine the frequency of undiagnosed AF and facilitate early stroke prevention. Methods: A quasi-experimental multicenter cross-sectional study was conducted in Community Pharmacies, Health Centers and Auxiliary Clinics in the Basic Health Area of Sagunto and Puerto de Sagunto (Spain) between April and June 2024. Community pharmacy users aged 55 years or older, with at least one risk factor, were included: hypertension, diabetes, heart failure, coronary heart disease, chronic kidney disease, BMI >30 kg/m 2 , obstructive sleep apnea and who had signed the informed consent form. Primary variable : 1-lead electrocardiogram (ECG) result. Results: 784 users were included, with a mean age of 70.1 years (SD = 8.0). From the 62 (7.9%) users identified with an alteration in the 1-lead ECG, 36 (58.1%) corresponded to a possible AF. Of these, thirty-four were referred to the Health Centre for confirmation by 12-lead ECG. Six patients (17.6%) were diagnosed with AF. Conclusions: opportunistic AF screening in community pharmacies, using portable technology, is a viable strategy to identify potential cases of undiagnosed AF in the at-risk population, contributing to early diagnosis of the arrhythmia and thus to stroke prevention. Trial registration: Not applicable. Atrial fibrillation screening community pharmacy Figures Figure 1 Figure 2 Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and a major risk factor for ischemic stroke. Its prevalence increases with age and the presence of cardiovascular risk factors such as hypertension, diabetes, and heart failure. Importantly, AF can remain asymptomatic or paroxysmal for years, and often goes unnoticed until it presents with a thromboembolic event. Early identification of AF, particularly in high-risk populations, is therefore a priority for stroke prevention ( 1 , 2 ). Multiple studies have shown that oral anticoagulation can significantly reduce stroke risk in patients with AF. However, this protective effect depends on timely diagnosis, which remains a challenge: a substantial proportion of AF cases are not identified under standard clinical care ( 3 , 4 ). Opportunistic screening using portable electrocardiogram (ECG) devices has emerged as a feasible and cost-effective strategy to detect undiagnosed AF in community and primary care settings ( 5 , 6 ). Recent international evidence supports the implementation of AF screening programs using single-lead ECG devices such as KardiaMobile. These devices offer high sensitivity and specificity, rapid results, and ease of use ( 7 ). Studies conducted in community pharmacies across Europe and North America have demonstrated detection rates of 1–5% for previously undiagnosed AF in individuals aged 60 and above ( 8 – 11 ). In Spain, the prevalence of undiagnosed AF is 2.2% of the outpatient population, according to the AFABE study, representing 20.1% of the total cases detected( 12 ). In addition, projects in France, Poland, and the United States have confirmed the feasibility and public health value of community pharmacy-based screening initiatives ( 9 – 11 ). Systematic reviews also affirm the diagnostic accuracy of portable ECG devices and endorse their use in opportunistic detection strategies targeting elderly or high-risk populations ( 7 , 13 ). Despite this growing body of evidence, few large-scale, real-world studies have been conducted in Southern European countries, where the burden of cardiovascular disease remains high. Furthermore, the role of community pharmacists in AF screening continues to be underused and under-evaluated. Pharmacists are in a strategic position to implement screening programs and provide counseling, referral, and coordination of care, especially for patients who may not regularly attend medical appointments ( 14 , 15 ). The PREVENIM ICTUS study was developed in this context to evaluate the feasibility and outcomes of an opportunistic AF screening program led by community pharmacists in Spain. Using a portable single-lead ECG device, the program aimed to detect previously undiagnosed AF in individuals aged 55 years or older with cardiovascular risk factors. The results of this study provide relevant data on the implementation of pharmacist-led AF screening in real-life community settings. The program has the following main objective: To determine the frequency of AF in undiagnosed population with concurrent risk factors and to prevent stroke risk by the early detection and collaboration of community pharmacists and Primary Health Care Pharmacists. Secondary objectives: To determine the frequency of tachycardia and bradycardia in an undiagnosed population with concurrent risk factors. Method A quasi-experimental multicenter cross-sectional study was conducted in Community Pharmacies, Health Centers and Auxiliary Clinics in the Basic Health Area of Sagunto and Puerto de Sagunto (Spain) between April and June 2024. The study population consisted of regular users of the participating Community Pharmacies who were registered in the Health Centers (HC): HC Sagunto, HC Puerto 1, HC Puerto 2, or Auxiliary Clinics (Baladre, Raval, Almardá and Canet). Inclusion criteria: community pharmacy users aged 55 years or older with undiagnosed AF and at least one of the following risk factors: hypertension, diabetes, heart failure, coronary heart disease, chronic kidney disease, BMI >30 kg/m 2 , obstructive sleep apnea, registered in the participating health centers or auxiliary clinics and who signed previously the informed consent form. Exclusion criteria: Community Pharmacy users under 55 years of age. Users with diagnosed AF, disabling and/or terminal illness, pacemaker, or implantable defibrillator. Users not registered in the participating Health Centers or Auxiliary Clinics. Users who did not sign the informed consent form. Variables Main variable: Result of the 1-lead ECG electrocardiogram. Four subgroups were established: 1. Possible AF: Supraventricular tachyarrhythmia with uncoordinated atrial electrical activation and consequently inefficient atrial contraction. 2. Bradycardia: Any heart rhythm with a heart rate (HR) less than 60 beats per minute (bpm). 3. Tachycardia: Any heart rhythm with a HR of more than 100 bpm. 4. Sinus rhythm: Sinus rhythm refers to the normal heart rhythm, in which the electrical impulse originates in the sinus node, located at the top of the right atrium of the heart. This node, considered the heart's natural pacemaker, generates electrical impulses at a regular, controlled rate. Patients with sinus rhythm have a regular heart rate between 60 and 100 bpm. Secondary: 1. User-related: age (years), sex (male/female), , Health Centre or Auxiliary Clinic to which he/she belongs, AF risk factors (hypertension, diabetes, heart failure, coronary heart disease, chronic kidney disease, obesity, BMI (kg/m 2 ), obstructive sleep apnea), heart rate (beats/minute), symptomatology (palpitations, dyspnea, tiredness, chest pain, dizziness, nervousness, cold sweats). 2. Diagnosis and treatment related: CHA 2 DS 2 -VASc (% risk of stroke in the next 12 months), confirmation of diagnosis (ICD-10) by 12-lead ECG, referral to Emergency Department (ED) (yes/no), referral to specialist (yes/no), initiation of treatment (yes/no). Procedure Prior to start of the study, participating community pharmacists received specific multidisciplinary face-to-face training related to AF, the procedure to be followed for the development of the program and the use of the device. The procedure to be followed is shown in Figure 1 and consists of the following: 1. Detection from the Community Pharmacy of users who met the inclusion criteria, information about the screening program, and invitation to participate. 2. Acceptance and signing of the informed consent form by the user. 3. Conduct the ECG with the Kardia Mobile 1-lead device for 30 seconds. 1. If the result was "sinus rhythm"; the user was given a report of the service provided with the result of the 1-lead ECG. 2. In the event of a "possible AF" result in a symptomatic or asymptomatic user, the risk of stroke was estimated using the CHA 2 DS 2 -VASc scale and the user was referred preferentially to the Health Centre, during Primary Health Care hours (8:00-14:00, Monday to Saturday) for diagnostic confirmation and referral to the ED or Specialist, as appropriate. 3. If the result was "bradycardia or tachycardia" in a symptomatic user, the user was referred preferentially to the Health Centre, during Primary Health Care hours (8:00-14:00, Monday to Saturday) for assessment. 4. If the result was "bradycardia or tachycardia" and the user was asymptomatic, the user was referred to the Health Centre for an appointment and assessment, during Primary Health Care hours (from 8:00-14:00, Monday to Saturday). Until the day of the appointment, the user was instructed to monitor their heart rate at home if they had the means to do so (pulsimeters, blood pressure monitors, etc.). If this was not the case, they were monitored at the Community Pharmacy. In cases b), c) and d) the Community Pharmacist gave the user a referral report to their Health Care Centre which included the ECG result, the CHA 2 DS 2 -VASc scale result (only if option b), the heart rate recording and the presence of symptoms, in their case. The user handed in the report at the counter of his/her Health Centre to be addressed on a preferential or ordinary basis, depending on the case. 4. Intervention by Primary Health Care Pharmacists and monitoring of users after review of Medical History: - Follow-up of referrals to the Health Centre and active recruitment of lost users. - Confirmation of risk factors and the result of the CHA 2 DS 2 -VASc scale. - Diagnostic confirmation by means of 12-lead ECG. - Outcome of referral to ED or specialist. - Treatment initiation. Data collection All information collected from each user, by the participating pharmacist, was recorded in an electronic lab notebook (ELN). The ELN was designed for this study as an independent module of the Atenfarma ® database, a computer software developed by the MICOF to manage and implement Clinical Pharmacy Services (CFS). Pharmacists accessed the data collection module through an URL with an access control system, so that each pharmacist could view their records. The pharmacists' records were structured in six sections: Health Centre, ECG result 1 referral and heart rate, Risk factors, Symptomatology, CHA 2 DS 2 -VASc scale and Referral to Health Centre if applicable. The Primary Health Care Pharmacists, on accessing their passwords, viewed all the records, selected those with alterations in the 1-lead ECG, confirmed the risk factors and the completion of the stroke risk scale through Medical History and recorded the result of the referral to the Health Centre. Sample size calculation The sample size was calculated using G*Power 3.1.9.7. Based on a one-sided binomial test with an expected prevalence of undiagnosed AF of 5%, a reference prevalence of 3% (based on published screening studies in similar populations(16)), a significance level of 5%, and a power of 80%, the required sample size was 465 participants. To account for potential data loss, we aim to recruit at least 500 individuals. Statistical treatment Quantitative variables were expressed as means, standard deviation and 95% CI. Relative frequencies were calculated for qualitative variables. Chi-square, Student's t-test, and one-way ANOVA were used to study the relationship between the different variables. It was considered significant when the p value < 0.05 and a statistical power (β) of 0.8. All statistical analyses were performed using SPSS 25.0 (SPSS, Chicago, IL, USA). Results Twenty-three pharmacies in the Basic Health Zone of Sagunto and Puerto de Sagunto (Spain) participated during the months of April, May, and June 2024. A summary of the main results is shown in Fig. 2 . A total of 784 users were included in the study, with a mean age of 70.1 (SD = 8.0) years and a range of 55–94. More than half of the users (56.5%) were women. Of the total, 45.2% were in the 65–74 age group. Although it was not a primary objective of our study, exploratory statistical analyses were performed to describe the distribution of cardiovascular risk factors by age and sex, aiming to provide context for the observed frequency of arrhythmic findings. These analyses help us to characterize the screened population observed. Men had a higher number of risk factors than women (mean: 1.80 vs. 1.64), a difference that was not statistically significant (p-value = 0.084). Of the total, 641 users (81.8%) had 1 (54.5%) or 2 (27.3%) risk factors; information documented by the Community Pharmacists from the interview with the participating users. The total average number of risk factors in the sample was 1.71 (SD = 0.94). Regarding the number of risk factors by age range, it is worth noting that patients between 65 and 84 years had a higher mean number of risk factors than those aged ≤ 64 and ≥ 85 years ( p > 0.05). Hypertension was the most frequent risk factor (76.9%), while chronic kidney disease was the least frequent (2.8%) (table 1) . Statistically significant differences were found in the prevalence of hypertension, diabetes, heart failure and obesity between age groups. Table 1 Type of risk factors distributed by age group Variable 55–64 n (%) 65–74 n (%) 75–84 n (%) > 85 n (%) Total n (%) p-value Arterial hypertension < 0.05 Yes 143 (74.1) 259 (73.2) 179 (85.6) 22 (78.6) 603 (76.9) No 50 (25.9) 95 (26.8) 30 (14.4) 6 (21.4) 181 (23.1) Diabetes < 0.05 Yes 41 (21.2) 118 (33.3) 65 (31.1) 6 (21.4) 230 (29.3) No 152 (78.8) 236 (66.7) 144 (68.9) 22 (78.6) 554 (70.7) Heart failure < 0.05 Yes 12 (6.2) 36 (10.2) 36 (17.2) 3 (10.7) 87 (11.1) No 181 (93.8) 318 (89.8) 173 (82.8) 25 (89.3) 697 (88.9) Coronary heart disease 0.249 Yes 50 ( 25 , 9 ) 106 ( 29 , 9 ) 56 ( 26 , 8 ) 12 (42,9) 224 ( 28 , 6 ) No 143 (74,1) 248 (70,1) 153 (73,2) 16 (57,1) 560 (71,4) Chronic kidney disease 0.518 Yes 3 (1.6) 13 (3.7) 5 (2.4) 1 (3.6) 22 (2.8) No 190 (98.4) 341 (96.3) 204 (97.6) 27 (96.4) 762 (97.2) Obesity < 0.05 Yes 42 (21.8) 56 (15.8) 19 (9.1) 2 (7.1) 119 (15.2) No 151 (78.2) 298 (84.2) 190 (90.9) 26 (92.9) 665 (84.8) Obstructive sleep apnea 0.067 Yes 17 (8.8) 29 (8.2) 8 (3.8) 0 (0.0) 54 (6.9) No 176 (91.2) 325 (91.8) 201 (96.2) 28 (100.0) 730 (93.1) n (%): number and percentage of patients analyzed according to the age group they belong, and the presence or absence of the risk factors studied. P-value: value obtained by Chi-square statistical analysis. The total number of users with an altered result (possible AF, tachycardia or bradycardia) in the 1-lead ECG was 62 (7.9%). The distribution of the results by age ranges is shown in table 2 . Table 2 1-lead ECG results distributed by age group Variable 55–64 n (%) 65–74 n (%) 75–84 n (%) > 85 n (%) Total n (%) Normal sinus rhythm 174 (90.2) 320 (90.4) 175 (83.7) 21 (75.0) 690 (88.0) Possible FA 4 (2.1) 16 (4.5) 13 (6.2) 3 (10.7) 36 (4.6) Unclassified 2 (1.0) 8 (2.3) 19 (9.1) 3 (10.7) 32 (4.1) Tachycardia 13 (6.7) 8 (2.3) 2 (1.0) 1 (3.6) 24 (3.1) Bradycardia 0 (0.0) 2 (0.6) 0 (0.0) 0 (0.0) 2 (0.3) 193 (100.0) 354 (100.0) 209 (100.0) 28 (100.0) 784 (100.0) AF: atrial fibrillation. n (%): number and percentage of patients analyzed according to the age group they belong to, and the result obtained in the 1-lead ECG. The 36 users with a 1-lead ECG result of “Possible AF” had a mean CHA 2 DS 2 -VASc score of 3.1 (SD = 1.4), equivalent to a mean 3.7% (SD = 2.0) risk of stroke in the next year. The distribution of the CHA 2 DS 2 -VASc scale results is presented in table 3 . Table 3 CHA 2 DS 2 -VASc scale result Score [Stroke risk] Total n (% total) 0 [0%] 1 (2.8) 1 [1.3%] 2 (5.6) 2 [2.2%] 11 (30.5) 3 [3.2%] 9 (25.0) 4 [4.0%] 5 (13.9) 5 [6.7%] 7 (19.4) 6 [9.8%] 1 (2.8) 36 (100.0) Of the total number of users with possible AF, tachycardia or bradycardia in the 1-lead ECG, 49 (79.0%) were referred to the Health Centre, 42 (85.7%) on a preferential basis and 7 (14.3%) on a routine basis, 37 (75.5%) went to the Health Centre and 34 (69.4%) had the 12-lead ECG performed. The results of the 12-lead ECG by age group are presented in table 4 . Table 4 12-lead ECG results distributed by age group Variable 55–64 n (%) 65–74 n (%) 75–84 n (%) > 85 n (%) Total n (%) p-value FA 0 (0.0) 2 (13.3) 4 (40.0) 0 (0.0) 6 (17.6) 0.533 Tachycardia 4 (50.0) 1 (6.7) 0 (0.0) 0 (0.0) 5 (14.7) Right Branch Blockage 1 (12.5) 1 (6.7) 0 (0.0) 0 (0.0) 2 (5.9) Left Branch Blockage 0 (0.0) 1 (6.7) 1 (10.0) 0 (0.0) 2 (5.9) Atrial Extrasystole 0 (0.0) 1 (6.7) 0 (0.0) 0 (0.0) 1 (2.9) Ventricular Extrasystole 0 (0.0) 0 (0.0) 1 (10.0) 0 (0.0) 1 (2.9) Atrial Bigeminy 0 (0.0) 1 (6.7) 0 (0.0) 0 (0.0) 1 (2.9) Normal sinus rhythm 3 (37.5) 8 (53.2) 4 (40.0) 1 (100.0) 16 (47.2) 8 (100.0) 15 (100.0) 10 (100.0) 1 (100.0) 34 (100.0) AF: atrial fibrillation. n (%): number and percentage of patients analyzed according to the age group they belong, and the result obtained in the 12-lead ECG P-value: obtained by Chi-square statistical analysis. Of the total number of users referred, 14 (28.6%) were diagnosed with a cardiac rhythm disturbance, of which 6 (12.2%) with AF, 5 (0.6%) with tachycardia, 1 (0.1%) with Right Bundle Branch Block, 1 (0.1%) with Ventricular Extrasystole and 1 (0.1%) with Atrial Bigeminy; the remaining 4 had a previous diagnosis. The 6 (100%) users diagnosed with AF were older than 65 years and younger than 85 years, had a mean risk factor score of 1.50 (SD = 1.0), and 5 (83.3%) of them had hypertension as a risk factor. These 6 users had a mean score of 3.17 (SD = 1.6) on the CHA 2 DS 2 -VASc scale, which is equivalent to a mean 3.9% (SD = 3.0) risk of stroke in the next year. Treatment was initiated in 5 of them, representing 83.3% of those diagnosed with AF. The positive predictive value (PPV) of the portable ECG device used in the study to identify users with abnormal ECG was 52.9%. Discussion Prevenim Ictus program has demonstrated the potential of community pharmacy as a key setting for opportunistic screening for undiagnosed AF, a condition with a significant impact on morbidity and mortality in the population over 65 years of age( 17 , 18 ). Recent studies suggest that early detection of AF through opportunistic strategies can reduce the risk of stroke by up to 70% in high-risk populations( 19 ). The results show that 4.6% of participants had a result indicative of possible AF using the Kardia Mobile device. However, after diagnostic confirmation by 12-lead ECG, the frequency of confirmed AF in the total sample was 0.8% (12.2% of referred users). This confirmed rate is similar to that of other studies that have reported prevalences of 0.49%-2.50% when diagnosed with standard ECG( 20 – 24 ) and up to 30% detected through continuous monitoring in patients with risk factors for stroke( 25 ). As in our study, other screening studies with similar technology have also reported higher initial rates that are reduced after diagnostic confirmation with 12-lead ECG( 26 ). Analysis of risk factors identified hypertension as the most frequent condition (76.9%), followed by diabetes mellitus (29.3%). Both factors have been widely documented in the literature as key elements in the increasing incidence of AF( 4 , 27 , 28 ). In addition, 5 of the 6 cases of AF confirmed by 12-lead ECG had hypertension, underlining its key role as a risk factor related to this arrhythmia. The relationship between age and frequency of AF has also been confirmed in the study given that 100% of the users diagnosed with AF were over 65 years of age. Studies such as OFRECE reported a prevalence of 6% in those over 60 years, 17.7% in those over 80 years and 10.7% in those over 85 years( 28 ), which reinforces the importance of targeting screening in these populations to increase its efficiency and maximize its impact. Similar findings were documented in recent cohort studies reporting an even higher prevalence in older age groups( 4 ). Of the 49 users referred to the health center, 75.5% attended and 69.4% had a 12-lead ECG performed. These data show that 1 in 4 users did not follow the recommendations of the community pharmacist, reflecting the need for adequate patient education on the importance of AF screening in stroke prevention. Early referral and diagnostic confirmation allowed treatment to be initiated in 83.3% of confirmed AF cases, thereby preventing the risk of stroke in this population. According to recent reviews, adequate oral anticoagulation can reduce the risk of stroke in AF patients by more than 60%( 29 ). The Kardia Mobile device showed a PPV of 52.9%. While this technology represents an accessible, rapid, and non-invasive solution for the initial detection of AF, the results need to be confirmed by more specific diagnostic tests, such as 12-lead ECG. According to the European Society of Cardiology guidelines, portable technology is a promising tool to improve arrhythmia detection in primary care( 17 , 30 ). In addition, recent studies have validated the accuracy of the device in various settings, reaching a sensitivity of 88% and a specificity of 97% in the identification of AF( 31 ). As strengths of the study, the close collaboration between community pharmacies and primary care pharmacy services has been fundamental to the success of the program, facilitating not only the early identification of patients with possible arrhythmia, but also the appropriate diagnostic confirmation and initiation of treatment. Interprofessional coordination has allowed optimization of patient follow-up, improving communication between the various levels of care and, consequently, contributing to stroke prevention. Similar models have demonstrated the effectiveness of multidisciplinary collaboration in several countries, supporting the value of the pharmacist as part of the care team ( 15 , 32 ). However, the quasi-experimental and cross-sectional design of the study does not allow causality between risk factors and detected AF to be established. In addition, the non-probabilistic sampling may limit the generalizability of the results. Another aspect to consider is the variability in the interpretation of recordings obtained with mobile devices, which could generate false positives or negatives depending on the operator's technique or environmental conditions. Conclusion Opportunistic screening for undiagnosed AF in community pharmacies using a portable ECG device is a feasible and effective strategy to identify hidden cases of AF in at-risk populations, allowing early interventions aimed at preventing the risk of stroke. The collaborative model between Community Pharmacists and Primary Health Care Pharmacists is confirmed to be an essential CFS in stroke prevention. Abbreviations • AF Atrial fibrillation • BMI Body mass index • CFS Clinical Pharmacy Services • CHA₂DS₂-VASc Congestive heart failure, Hypertension, Age ≥ 75 years (doubled), Diabetes mellitus, prior Stroke/transient ischaemic attack (doubled), Vascular disease, Age 65–74 years, Sex category (female) score • CI Confidence interval • ECG Electrocardiogram • ED Emergency Department • ELN Electronic laboratory notebook • GCP Good Clinical Practice • GDPR General Data Protection Regulation • HC Health Centre • HR Heart rate • ICH International Conference on Harmonization • MICOF Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia • SD Standard deviation • UV University of Valencia Declarations Acknowledgements To the community pharmacists of the 23 pharmacies and the Primary Care pharmacists who participated in this study. Ethics approval and consent to participate The study was conducted in accordance with the "Ethical Principles for Medical Research Involving Human Subjects" contained in the Declaration of Helsinki (Fortaleza, October 2013). Likewise, the study was conducted according to a protocol and based on procedures that ensured compliance with the ICH/GCP (International Conference on Harmonization) Good Clinical Practice guidelines. The protection of personal privacy and the confidential treatment of personal data resulting from the research activity were guaranteed in accordance with the provisions of the General Data Protection Regulation (GDPR) and Organic Law 3/2018, of 5 December, on the Protection of Personal Data and Guarantee of Digital Rights. This study was reviewed and approved by the Sagunto Hospital Research Ethics Committee (PREVENIM 2.0, approval date: 06 March 2024). All participants signed written informed consent in accordance with the Declaration of Helsinki. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Consent for publication Not applicable. This manuscript does not contain data from any individual person, including individual details, images, or videos. Competing interests The authors declare no competing interests. Funding The program was promoted by the Fundación de la Comunidad Valenciana Sustainable Pharmacy and funded by Alive Health Systems, S.L. and by KRKA Farmacéutica S.L. References Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 25 de febrero de. 2014;129(8):837–47. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 7 de octubre de. 2016;37(38):2893–962. Lowres N, Neubeck L, Redfern J, Freedman SB. Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost agosto de. 2013;110(2):213–22. Svennberg E, Engdahl J, Al-Khalili F, Friberg L, Frykman V, Rosenqvist M. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation. 23 de junio de. 2015;131(25):2176-84. Wahab A, Nadarajah R, Larvin H, Farooq M, Raveendra K, Haris M, et al. Systematic screening for atrial fibrillation with non-invasive devices: a systematic review and meta-analysis. Lancet Reg Health Eur junio de. 2025;53:101298. Gu HY, Huang J, Liu X, Qiao SQ, Cao X. Effectiveness of single-lead ECG devices for detecting atrial fibrillation: An overview of systematic reviews. Worldviews Evid Based Nurs febrero de. 2024;21(1):79–86. Kahwati LC, Asher GN, Kadro ZO, Keen S, Ali R, Coker-Schwimmer E et al. Screening for Atrial Fibrillation: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 25 de enero de 2022;327(4):368–83. Bleske BE, Raley RE, Hunter TS, Anderson JR. Curricular-driven screening for atrial fibrillation at community pharmacies. J Am Pharm Assoc JAPhA. 2022;62(2):541–e5451. Olindo S, Renou P, Martial F, Heyvang N, Milan L, Ledure S et al. Pharmacy-Based Opportunistic Atrial Fibrillation Screening at a Community Level: A Real-Life Study. Healthc Basel Switz. 4 de enero de. 2022;10(1):90. Zaprutko T, Zaprutko J, Baszko A, Sawicka D, Szałek A, Dymecka M, et al. Feasibility of Atrial Fibrillation Screening With Mobile Health Technologies at Pharmacies. J Cardiovasc Pharmacol Ther marzo de. 2020;25(2):142–51. Little J, Bonham AJ, Bluml BM, Solutions for Atrial Fibrillation Edvocacy (SAFE). Innov Pharm 10 de octubre de. 2023;14(2). 10.24926/iip.v14i2.5477 . Improving Awareness And Access To Afib Screening For Detection And Referral For Treatment. Clua-Espuny JL, Lechuga-Duran I, Bosch-Princep R, Roso-Llorach A, Panisello-Tafalla A, Lucas-Noll J, et al. Prevalence of undiagnosed atrial fibrillation and of that not being treated with anticoagulant drugs: the AFABE study. Rev Esp Cardiol Engl Ed julio de. 2013;66(7):545–52. Canty E, MacGilchrist C, Tawfick W, McIntosh C. Screening for Atrial Fibrillation in Community and Primary CareSettings: A Scoping Review. J Atr Fibrillation. 2021;13(5):2452. Dhutia H, Malhotra A, Finocchiaro G, Parpia S, Bhatia R, D’Silva A et al. Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol. 6 de agosto de. 2021;23(8):1295 – 301. Ritchie LA, Penson PE, Akpan A, Lip GYH, Lane DA. Integrated Care for Atrial Fibrillation Management: The Role of the Pharmacist. Am J Med diciembre de. 2022;135(12):1410–26. Khurshid S, Choi SH, Weng LC, Wang EY, Trinquart L, Benjamin EJ, et al. Frequency of Cardiac Rhythm Abnormalities in a Half Million Adults. Circ Arrhythm Electrophysiol julio de. 2018;11(7):e006273. Jones NR, Taylor CJ, Hobbs FDR, Bowman L, Casadei B. Screening for atrial fibrillation: a call for evidence. Eur Heart J 7 de marzo de. 2020;41(10):1075–85. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 1 de febrero de. 2021;42(5):373–498. Birkemeyer R, Müller A, Wahler S, von der Schulenburg JM. A cost-effectiveness analysis model of Preventicus atrial fibrillation screening from the point of view of statutory health insurance in Germany. Health Econ Rev 9 de junio de. 2020;10(1):16. Daniëls F, Ramdjan TTTK, Mánfai B, Adiyaman A, Smit JJJ, Delnoy PPHM, et al. Detection of atrial fibrillation in persons aged 65 years and above using a mobile electrocardiogram device. Neth Heart J 1 de abril de. 2024;32(4):160–6. Fitzmaurice DA, Hobbs FDR, Jowett S, Mant J, Murray ET, Holder R, et al. Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ 25 de agosto de. 2007;335(7616):383. Morillas P, Pallarés V, Llisterri JL, Sanchis C, Sánchez T, Fácila L, et al. Prevalencia de fibrilación auricular y uso de fármacos antitrombóticos en el paciente hipertenso ≥ 65 años. El registro FAPRES. Rev Esp Cardiol agosto de. 2010;63(8):943–50. Labrador García MS, Merino Segovia R, Jiménez Domínguez C, García Salvador Y, Segura Fragoso A, Hernández Lanchas C. Prevalencia de fibrilación auricular en mayores de 65 años de una zona de salud. Aten Primaria. 2001;28(10):648–51. Tveit A, Abdelnoor M, Enger S, Smith P. Atrial fibrillation and antithrombotic therapy in a 75-year-old population. Cardiology. 2008;109(4):258–62. Ziegler PD, Glotzer TV, Daoud EG, Singer DE, Ezekowitz MD, Hoyt RH et al. Detection of previously undiagnosed atrial fibrillation in patients with stroke risk factors and usefulness of continuous monitoring in primary stroke prevention. Am J Cardiol. 1 de noviembre de. 2012;110(9):1309-14. Kakkar AK, Mueller I, Bassand JP, Fitzmaurice DA, Goldhaber SZ, Goto S, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS ONE. 2013;8(5):e63479. Krijthe BP, Kunst A, Benjamin EJ, Lip GYH, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J septiembre de. 2013;34(35):2746–51. Gómez-Doblas JJ, Muñiz J, Martin JJA, Rodríguez-Roca G, Lobos JM, Awamleh P, et al. Prevalence of atrial fibrillation in Spain. OFRECE study results. Rev Esp Cardiol Engl Ed abril de. 2014;67(4):259–69. Langén V, Winstén AK, Airaksinen KEJ, Teppo K. Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials. Ann Med. 57(1):2457522. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 29 de septiembre de. 2024;45(36):3314–414. Klier K, Koch L, Graf L, Schinköthe T, Schmidt A. Diagnostic Accuracy of Single-Lead Electrocardiograms Using the Kardia Mobile App and the Apple Watch 4: Validation Study. JMIR Cardio. 23 de noviembre de 2023;7:e50701. Savickas V, Stewart AJ, Short VJ, Mathie A, Bhamra SK, Veale EL, et al. Screening for atrial fibrillation in care homes using pulse palpation and the AliveCor Kardia Mobile® device: a comparative cross-sectional pilot study. Int J Clin Pharm 1 de abril de. 2024;46(2):529–35. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Jan, 2026 Read the published version in BMC Primary Care → Version 1 posted Editorial decision: Revision requested 01 Dec, 2025 Reviews received at journal 29 Nov, 2025 Reviewers agreed at journal 11 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviews received at journal 10 Nov, 2025 Reviewers agreed at journal 09 Nov, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers invited by journal 01 Oct, 2025 Editor assigned by journal 03 Aug, 2025 Submission checks completed at journal 03 Aug, 2025 First submitted to journal 31 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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06:42:12","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127044,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7262408/v1/31c1bfd851a6296b7eb1daa9.html"},{"id":93556273,"identity":"263dd345-cfce-4920-bcbd-e6ae14dba63a","added_by":"auto","created_at":"2025-10-15 06:42:11","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":237744,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram of the procedure followed by community pharmacists. It represents the method of user’s recruitment, and the final results obtained.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7262408/v1/284e36dc5be9daf6b87afe4b.jpeg"},{"id":93556270,"identity":"457ca7a3-18e2-488a-89ef-328a2b2d9401","added_by":"auto","created_at":"2025-10-15 06:42:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41048,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram of results.\u003c/p\u003e","description":"","filename":"floatimage313.png","url":"https://assets-eu.researchsquare.com/files/rs-7262408/v1/577eb5c73761a72d1f0ef8a0.png"},{"id":101690661,"identity":"39971750-bfe1-4eb0-8b6d-4c6ab4885987","added_by":"auto","created_at":"2026-02-02 16:07:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1081989,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7262408/v1/0c138785-fea7-4e2b-9fdc-49755ba4bbf9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Screening for Undiagnosed Atrial Fibrillation in Community Pharmacies using mobile electrocardiogram technology: A Quasi-Experimental Cross- Sectional Study (PREVENIM ICTUS)","fulltext":[{"header":"Background","content":"\u003cp\u003eAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and a major risk factor for ischemic stroke. Its prevalence increases with age and the presence of cardiovascular risk factors such as hypertension, diabetes, and heart failure. Importantly, AF can remain asymptomatic or paroxysmal for years, and often goes unnoticed until it presents with a thromboembolic event. Early identification of AF, particularly in high-risk populations, is therefore a priority for stroke prevention (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMultiple studies have shown that oral anticoagulation can significantly reduce stroke risk in patients with AF. However, this protective effect depends on timely diagnosis, which remains a challenge: a substantial proportion of AF cases are not identified under standard clinical care (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Opportunistic screening using portable electrocardiogram (ECG) devices has emerged as a feasible and cost-effective strategy to detect undiagnosed AF in community and primary care settings (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent international evidence supports the implementation of AF screening programs using single-lead ECG devices such as KardiaMobile. These devices offer high sensitivity and specificity, rapid results, and ease of use (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Studies conducted in community pharmacies across Europe and North America have demonstrated detection rates of 1–5% for previously undiagnosed AF in individuals aged 60 and above (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In Spain, the prevalence of undiagnosed AF is 2.2% of the outpatient population, according to the AFABE study, representing 20.1% of the total cases detected(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition, projects in France, Poland, and the United States have confirmed the feasibility and public health value of community pharmacy-based screening initiatives (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Systematic reviews also affirm the diagnostic accuracy of portable ECG devices and endorse their use in opportunistic detection strategies targeting elderly or high-risk populations (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite this growing body of evidence, few large-scale, real-world studies have been conducted in Southern European countries, where the burden of cardiovascular disease remains high. Furthermore, the role of community pharmacists in AF screening continues to be underused and under-evaluated. Pharmacists are in a strategic position to implement screening programs and provide counseling, referral, and coordination of care, especially for patients who may not regularly attend medical appointments (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe \u003cb\u003ePREVENIM ICTUS\u003c/b\u003e study was developed in this context to evaluate the feasibility and outcomes of an opportunistic AF screening program led by community pharmacists in Spain. Using a portable single-lead ECG device, the program aimed to detect previously undiagnosed AF in individuals aged 55 years or older with cardiovascular risk factors. The results of this study provide relevant data on the implementation of pharmacist-led AF screening in real-life community settings.\u003c/p\u003e\u003cp\u003eThe program has the following main objective:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo determine the frequency of AF in undiagnosed population with concurrent risk factors and to prevent stroke risk by the early detection and collaboration of community pharmacists and Primary Health Care Pharmacists.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSecondary objectives:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col start=2\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo determine the frequency of tachycardia and bradycardia in an undiagnosed population with concurrent risk factors.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e"},{"header":"Method","content":"\u003cp\u003eA quasi-experimental multicenter cross-sectional study was conducted in Community Pharmacies, Health Centers and Auxiliary Clinics in the Basic Health Area of Sagunto and Puerto de Sagunto (Spain) between April and June 2024. The study population consisted of regular users of the participating Community Pharmacies who were registered in the Health Centers (HC): HC Sagunto, HC Puerto 1, HC Puerto 2, or Auxiliary Clinics (Baladre, Raval, Almard\u0026aacute; and Canet).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion criteria:\u0026nbsp;\u003c/em\u003ecommunity pharmacy users aged 55 years or older with undiagnosed AF and at least one of the following risk factors: hypertension, diabetes, heart failure, coronary heart disease, chronic kidney disease, BMI \u0026gt;30 kg/m\u003csup\u003e2\u003c/sup\u003e, obstructive sleep apnea, registered in the participating health centers or auxiliary clinics and who signed previously the informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExclusion criteria:\u0026nbsp;\u003c/em\u003eCommunity Pharmacy users under 55 years of age. Users with diagnosed AF, disabling and/or terminal illness, pacemaker, or implantable defibrillator. Users not registered in the participating Health Centers or Auxiliary Clinics. Users who did not sign the informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMain variable:\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eResult of the 1-lead ECG electrocardiogram. Four subgroups were established:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Possible AF: Supraventricular tachyarrhythmia with uncoordinated atrial electrical activation and consequently inefficient atrial contraction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Bradycardia: Any heart rhythm with a heart rate (HR) less than 60 beats per minute (bpm).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tachycardia: Any heart rhythm with a HR of more than 100 bpm.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sinus rhythm: Sinus rhythm refers to the normal heart rhythm, in which the electrical impulse originates in the sinus node, located at the top of the right atrium of the heart. This node, considered the heart\u0026apos;s natural pacemaker, generates electrical impulses at a regular, controlled rate. Patients with sinus rhythm have a regular heart rate between 60 and 100 bpm.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eSecondary:\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e1. \u0026nbsp;User-related: age (years), sex (male/female), , Health Centre or Auxiliary Clinic to which he/she belongs, AF risk factors (hypertension, diabetes, heart failure, coronary heart disease, chronic kidney disease, obesity, BMI (kg/m\u003csup\u003e2\u003c/sup\u003e), obstructive sleep apnea), heart rate (beats/minute), symptomatology (palpitations, dyspnea, tiredness, chest pain, dizziness, nervousness, cold sweats).\u003c/p\u003e\n\u003cp\u003e2. \u0026nbsp;Diagnosis and treatment related: CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc (% risk of stroke in the next 12 months), confirmation of diagnosis (ICD-10) by 12-lead ECG, referral to Emergency Department (ED) (yes/no), referral to specialist (yes/no), initiation of treatment (yes/no).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to start of the study, participating community pharmacists received specific multidisciplinary face-to-face training related to AF, the procedure to be followed for the development of the program and the use of the device.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe procedure to be followed is shown in \u003cem\u003eFigure 1\u0026nbsp;\u003c/em\u003eand consists of the following:\u003c/p\u003e\n\u003cp\u003e1. Detection from the Community Pharmacy of users who met the inclusion criteria, information about the screening program, and invitation to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Acceptance and signing of the informed consent form by the user.\u003c/p\u003e\n\u003cp\u003e3. Conduct the ECG with the Kardia Mobile 1-lead device for 30 seconds.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. \u0026nbsp;If the result was \u0026quot;sinus rhythm\u0026quot;; the user was given a report of the service provided with the result of the 1-lead ECG.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. \u0026nbsp;In the event of a \u0026quot;possible AF\u0026quot; result in a symptomatic or asymptomatic user, the risk of stroke was estimated using the CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc scale and the user was referred preferentially to the Health Centre, during Primary Health Care hours (8:00-14:00, Monday to Saturday) for diagnostic confirmation and referral to the ED or Specialist, as appropriate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. \u0026nbsp;If the result was \u0026quot;bradycardia or tachycardia\u0026quot; in a symptomatic user, the user was referred preferentially to the Health Centre, during Primary Health Care hours (8:00-14:00, Monday to Saturday) for assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. \u0026nbsp;If the result was \u0026quot;bradycardia or tachycardia\u0026quot; and the user was asymptomatic, the user was referred to the Health Centre for an appointment and assessment, during Primary Health Care hours (from 8:00-14:00, Monday to Saturday). Until the day of the appointment, the user was instructed to monitor their heart rate at home if they had the means to do so (pulsimeters, blood pressure monitors, etc.). If this was not the case, they were monitored at the Community Pharmacy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn cases b), c) and d) the Community Pharmacist gave the user a referral report to their Health Care Centre which included the ECG result, the CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc scale result (only if option b), the heart rate recording and the presence of symptoms, in their case. The user handed in the report at the counter of his/her Health Centre to be addressed on a preferential or ordinary basis, depending on the case.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Intervention by Primary Health Care Pharmacists and monitoring of users after review of Medical History:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Follow-up of referrals to the Health Centre and active recruitment of lost users.\u003c/p\u003e\n\u003cp\u003e- Confirmation of risk factors and the result of the CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc scale.\u003c/p\u003e\n\u003cp\u003e- Diagnostic confirmation by means of 12-lead ECG.\u003c/p\u003e\n\u003cp\u003e- Outcome of referral to ED or specialist.\u003c/p\u003e\n\u003cp\u003e- Treatment initiation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll information collected from each user, by the participating pharmacist, was recorded in an electronic lab notebook (ELN).\u003c/p\u003e\n\u003cp\u003eThe ELN was designed for this study as an independent module of the Atenfarma\u003csup\u003e\u0026reg;\u003c/sup\u003e database, a computer software developed by the MICOF to manage and implement Clinical Pharmacy Services (CFS). Pharmacists accessed the data collection module through an URL with an access control system, so that each pharmacist could view their records. The pharmacists\u0026apos; records were structured in six sections: Health Centre, ECG result 1 referral and heart rate, Risk factors, Symptomatology, CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc scale and Referral to Health Centre if applicable. The Primary Health Care Pharmacists, on accessing their passwords, viewed all the records, selected those with alterations in the 1-lead ECG, confirmed the risk factors and the completion of the stroke risk scale through Medical History and recorded the result of the referral to the Health Centre.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using G*Power 3.1.9.7. Based on a one-sided binomial test with an expected prevalence of undiagnosed AF of 5%, a reference prevalence of 3% (based on published screening studies in similar populations(16)), a significance level of 5%, and a power of 80%, the required sample size was 465 participants. To account for potential data loss, we aim to recruit at least 500 individuals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative variables were expressed as means, standard deviation and 95% CI. Relative frequencies were calculated for qualitative variables. Chi-square, Student\u0026apos;s t-test, and one-way ANOVA were used to study the relationship between the different variables. It was considered significant when the p value \u0026lt; 0.05 and a statistical power (\u0026beta;) of 0.8.\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS 25.0 (SPSS, Chicago, IL, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTwenty-three pharmacies in the Basic Health Zone of Sagunto and Puerto de Sagunto (Spain) participated during the months of April, May, and June 2024. A summary of the main results is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA total of 784 users were included in the study, with a mean age of 70.1 (SD\u0026thinsp;=\u0026thinsp;8.0) years and a range of 55\u0026ndash;94. More than half of the users (56.5%) were women. Of the total, 45.2% were in the 65\u0026ndash;74 age group.\u003c/p\u003e\u003cp\u003eAlthough it was not a primary objective of our study, exploratory statistical analyses were performed to describe the distribution of cardiovascular risk factors by age and sex, aiming to provide context for the observed frequency of arrhythmic findings. These analyses help us to characterize the screened population observed.\u003c/p\u003e\u003cp\u003eMen had a higher number of risk factors than women (mean: 1.80 vs. 1.64), a difference that was not statistically significant (p-value\u0026thinsp;=\u0026thinsp;0.084).\u003c/p\u003e\u003cp\u003eOf the total, 641 users (81.8%) had 1 (54.5%) or 2 (27.3%) risk factors; information documented by the Community Pharmacists from the interview with the participating users.\u003c/p\u003e\u003cp\u003eThe total average number of risk factors in the sample was 1.71 (SD\u0026thinsp;=\u0026thinsp;0.94). Regarding the number of risk factors by age range, it is worth noting that patients between 65 and 84 years had a higher mean number of risk factors than those aged\u0026thinsp;\u0026le;\u0026thinsp;64 and \u0026ge;\u0026thinsp;85 years (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eHypertension was the most frequent risk factor (76.9%), while chronic kidney disease was the least frequent (2.8%) \u003cb\u003e(table 1)\u003c/b\u003e. Statistically significant differences were found in the prevalence of hypertension, diabetes, heart failure and obesity between age groups.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eType of risk factors distributed by age group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u0026ndash;64 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u0026ndash;74 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u0026ndash;84 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;85\u003c/em\u003e n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eArterial hypertension\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143 (74.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e259 (73.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e179 (85.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (78.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e603 (76.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95 (26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e181 (23.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eDiabetes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65 (31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e230 (29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e152 (78.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e236 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144 (68.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (78.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e554 (70.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHeart failure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e87 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e181 (93.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e318 (89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e173 (82.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (89.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e697 (88.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eCoronary heart disease\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (42,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e224 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143 (74,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e248 (70,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e153 (73,2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (57,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e560 (71,4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eChronic kidney disease\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.518\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e190 (98.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e341 (96.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e204 (97.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27 (96.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e762 (97.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eObesity\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (21.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e119 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e151 (78.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e298 (84.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e190 (90.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (92.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e665 (84.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eObstructive sleep apnea\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (8.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176 (91.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e325 (91.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e201 (96.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e730 (93.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003en (%): number and percentage of patients analyzed according to the age group they belong, and the presence or absence of the risk factors studied. P-value: value obtained by Chi-square statistical analysis.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe total number of users with an altered result (possible AF, tachycardia or bradycardia) in the 1-lead ECG was 62 (7.9%). The distribution of the results by age ranges is shown in \u003cb\u003etable 2\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003e1-lead ECG results distributed by age group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u0026ndash;64 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65\u0026ndash;74 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75\u0026ndash;84 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;85\u003c/em\u003e n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNormal sinus rhythm\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e174 (90.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e320 (90.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e175 (83.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e690 (88.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"5\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePossible FA\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36 (4.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eUnclassified\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32 (4.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eTachycardia\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBradycardia\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e354 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e209 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e784 (100.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eAF: atrial fibrillation. n (%): number and percentage of patients analyzed according to the age group they belong to, and the result obtained in the 1-lead ECG.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe 36 users with a 1-lead ECG result of \u0026ldquo;Possible AF\u0026rdquo; had a mean CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc score of 3.1 (SD\u0026thinsp;=\u0026thinsp;1.4), equivalent to a mean 3.7% (SD\u0026thinsp;=\u0026thinsp;2.0) risk of stroke in the next year. The distribution of the CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc scale results is presented in \u003cb\u003etable 3\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc scale result\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eScore [Stroke risk]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal n (% total)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e0 [0%]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e1 [1.3%]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e2 [2.2%]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (30.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e3 [3.2%]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (25.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e4 [4.0%]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e5 [6.7%]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (19.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e6 [9.8%]\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (100.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOf the total number of users with possible AF, tachycardia or bradycardia in the 1-lead ECG, 49 (79.0%) were referred to the Health Centre, 42 (85.7%) on a preferential basis and 7 (14.3%) on a routine basis, 37 (75.5%) went to the Health Centre and 34 (69.4%) had the 12-lead ECG performed. The results of the 12-lead ECG by age group are presented \u003cb\u003ein table 4\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003e12-lead ECG results distributed by age group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u0026ndash;64 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65\u0026ndash;74 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75\u0026ndash;84 n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;85\u003c/em\u003e n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFA\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 (17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.533\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eTachycardia\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (14.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eRight Branch Blockage\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eLeft Branch Blockage\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAtrial Extrasystole\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eVentricular Extrasystole\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAtrial Bigeminy\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNormal sinus rhythm\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (53.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16 (47.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e34 (100.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eAF: atrial fibrillation. n (%): number and percentage of patients analyzed according to the age group they belong, and the result obtained in the 12-lead ECG P-value: obtained by Chi-square statistical analysis.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOf the total number of users referred, 14 (28.6%) were diagnosed with a cardiac rhythm disturbance, of which 6 (12.2%) with AF, 5 (0.6%) with tachycardia, 1 (0.1%) with Right Bundle Branch Block, 1 (0.1%) with Ventricular Extrasystole and 1 (0.1%) with Atrial Bigeminy; the remaining 4 had a previous diagnosis.\u003c/p\u003e\u003cp\u003eThe 6 (100%) users diagnosed with AF were older than 65 years and younger than 85 years, had a mean risk factor score of 1.50 (SD\u0026thinsp;=\u0026thinsp;1.0), and 5 (83.3%) of them had hypertension as a risk factor. These 6 users had a mean score of 3.17 (SD\u0026thinsp;=\u0026thinsp;1.6) on the CHA\u003csub\u003e2\u003c/sub\u003eDS\u003csub\u003e2\u003c/sub\u003e-VASc scale, which is equivalent to a mean 3.9% (SD\u0026thinsp;=\u0026thinsp;3.0) risk of stroke in the next year. Treatment was initiated in 5 of them, representing 83.3% of those diagnosed with AF.\u003c/p\u003e\u003cp\u003eThe positive predictive value (PPV) of the portable ECG device used in the study to identify users with abnormal ECG was 52.9%.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003ePrevenim Ictus\u003c/em\u003e program has demonstrated the potential of community pharmacy as a key setting for opportunistic screening for undiagnosed AF, a condition with a significant impact on morbidity and mortality in the population over 65 years of age(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Recent studies suggest that early detection of AF through opportunistic strategies can reduce the risk of stroke by up to 70% in high-risk populations(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe results show that 4.6% of participants had a result indicative of possible AF using the Kardia Mobile device. However, after diagnostic confirmation by 12-lead ECG, the frequency of confirmed AF in the total sample was 0.8% (12.2% of referred users). This confirmed rate is similar to that of other studies that have reported prevalences of 0.49%-2.50% when diagnosed with standard ECG(\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and up to 30% detected through continuous monitoring in patients with risk factors for stroke(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). As in our study, other screening studies with similar technology have also reported higher initial rates that are reduced after diagnostic confirmation with 12-lead ECG(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnalysis of risk factors identified hypertension as the most frequent condition (76.9%), followed by diabetes mellitus (29.3%). Both factors have been widely documented in the literature as key elements in the increasing incidence of AF(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In addition, 5 of the 6 cases of AF confirmed by 12-lead ECG had hypertension, underlining its key role as a risk factor related to this arrhythmia.\u003c/p\u003e\u003cp\u003eThe relationship between age and frequency of AF has also been confirmed in the study given that 100% of the users diagnosed with AF were over 65 years of age. Studies such as OFRECE reported a prevalence of 6% in those over 60 years, 17.7% in those over 80 years and 10.7% in those over 85 years(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), which reinforces the importance of targeting screening in these populations to increase its efficiency and maximize its impact. Similar findings were documented in recent cohort studies reporting an even higher prevalence in older age groups(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOf the 49 users referred to the health center, 75.5% attended and 69.4% had a 12-lead ECG performed. These data show that 1 in 4 users did not follow the recommendations of the community pharmacist, reflecting the need for adequate patient education on the importance of AF screening in stroke prevention. Early referral and diagnostic confirmation allowed treatment to be initiated in 83.3% of confirmed AF cases, thereby preventing the risk of stroke in this population. According to recent reviews, adequate oral anticoagulation can reduce the risk of stroke in AF patients by more than 60%(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Kardia Mobile device showed a PPV of 52.9%. While this technology represents an accessible, rapid, and non-invasive solution for the initial detection of AF, the results need to be confirmed by more specific diagnostic tests, such as 12-lead ECG. According to the European Society of Cardiology guidelines, portable technology is a promising tool to improve arrhythmia detection in primary care(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In addition, recent studies have validated the accuracy of the device in various settings, reaching a sensitivity of 88% and a specificity of 97% in the identification of AF(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs strengths of the study, the close collaboration between community pharmacies and primary care pharmacy services has been fundamental to the success of the program, facilitating not only the early identification of patients with possible arrhythmia, but also the appropriate diagnostic confirmation and initiation of treatment. Interprofessional coordination has allowed optimization of patient follow-up, improving communication between the various levels of care and, consequently, contributing to stroke prevention. Similar models have demonstrated the effectiveness of multidisciplinary collaboration in several countries, supporting the value of the pharmacist as part of the care team (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, the quasi-experimental and cross-sectional design of the study does not allow causality between risk factors and detected AF to be established. In addition, the non-probabilistic sampling may limit the generalizability of the results. Another aspect to consider is the variability in the interpretation of recordings obtained with mobile devices, which could generate false positives or negatives depending on the operator's technique or environmental conditions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOpportunistic screening for undiagnosed AF in community pharmacies using a portable ECG device is a feasible and effective strategy to identify hidden cases of AF in at-risk populations, allowing early interventions aimed at preventing the risk of stroke. The collaborative model between Community Pharmacists and Primary Health Care Pharmacists is confirmed to be an essential CFS in stroke prevention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eAF\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAtrial fibrillation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCFS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eClinical Pharmacy Services\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHA₂DS₂-VASc\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCongestive heart failure, Hypertension, Age\u0026thinsp;\u0026ge;\u0026thinsp;75 years (doubled), Diabetes mellitus, prior Stroke/transient ischaemic attack (doubled), Vascular disease, Age 65\u0026ndash;74 years, Sex category (female) score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eECG\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eElectrocardiogram\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eED\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eELN\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eElectronic laboratory notebook\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eGCP\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGood Clinical Practice\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eGDPR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGeneral Data Protection Regulation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eHC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHealth Centre\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eHR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHeart rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eICH\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Conference on Harmonization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eMICOF\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMuy Ilustre Colegio Oficial de Farmac\u0026eacute;uticos de Valencia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eUV\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUniversity of Valencia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo the community pharmacists of the 23 pharmacies and the Primary Care pharmacists who participated in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the \u0026quot;Ethical Principles for Medical Research Involving Human Subjects\u0026quot; contained in the Declaration of Helsinki (Fortaleza, October 2013). Likewise, the study was conducted according to a protocol and based on procedures that ensured compliance with the ICH/GCP (International Conference on Harmonization) Good Clinical Practice guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe protection of personal privacy and the confidential treatment of personal data resulting from the research activity were guaranteed in accordance with the provisions of the General Data Protection Regulation (GDPR) and Organic Law 3/2018, of 5 December, on the Protection of Personal Data and Guarantee of Digital Rights.\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Sagunto Hospital Research Ethics Committee (PREVENIM 2.0, approval date: 06 March 2024). All participants signed written informed consent in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain data from any individual person, including individual details, images, or videos.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe program was promoted by the Fundaci\u0026oacute;n de la Comunidad Valenciana Sustainable Pharmacy and funded by Alive Health Systems, S.L. and by KRKA Farmac\u0026eacute;utica S.L.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 25 de febrero de. 2014;129(8):837\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 7 de octubre de. 2016;37(38):2893\u0026ndash;962.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLowres N, Neubeck L, Redfern J, Freedman SB. Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost agosto de. 2013;110(2):213\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSvennberg E, Engdahl J, Al-Khalili F, Friberg L, Frykman V, Rosenqvist M. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation. 23 de junio de. 2015;131(25):2176-84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWahab A, Nadarajah R, Larvin H, Farooq M, Raveendra K, Haris M, et al. Systematic screening for atrial fibrillation with non-invasive devices: a systematic review and meta-analysis. Lancet Reg Health Eur junio de. 2025;53:101298.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGu HY, Huang J, Liu X, Qiao SQ, Cao X. Effectiveness of single-lead ECG devices for detecting atrial fibrillation: An overview of systematic reviews. Worldviews Evid Based Nurs febrero de. 2024;21(1):79\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKahwati LC, Asher GN, Kadro ZO, Keen S, Ali R, Coker-Schwimmer E et al. Screening for Atrial Fibrillation: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 25 de enero de 2022;327(4):368\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBleske BE, Raley RE, Hunter TS, Anderson JR. Curricular-driven screening for atrial fibrillation at community pharmacies. J Am Pharm Assoc JAPhA. 2022;62(2):541\u0026ndash;e5451.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlindo S, Renou P, Martial F, Heyvang N, Milan L, Ledure S et al. Pharmacy-Based Opportunistic Atrial Fibrillation Screening at a Community Level: A Real-Life Study. Healthc Basel Switz. 4 de enero de. 2022;10(1):90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZaprutko T, Zaprutko J, Baszko A, Sawicka D, Szałek A, Dymecka M, et al. Feasibility of Atrial Fibrillation Screening With Mobile Health Technologies at Pharmacies. J Cardiovasc Pharmacol Ther marzo de. 2020;25(2):142\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLittle J, Bonham AJ, Bluml BM, Solutions for Atrial Fibrillation Edvocacy (SAFE). Innov Pharm 10 de octubre de. 2023;14(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.24926/iip.v14i2.5477\u003c/span\u003e\u003cspan address=\"10.24926/iip.v14i2.5477\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Improving Awareness And Access To Afib Screening For Detection And Referral For Treatment.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClua-Espuny JL, Lechuga-Duran I, Bosch-Princep R, Roso-Llorach A, Panisello-Tafalla A, Lucas-Noll J, et al. Prevalence of undiagnosed atrial fibrillation and of that not being treated with anticoagulant drugs: the AFABE study. Rev Esp Cardiol Engl Ed julio de. 2013;66(7):545\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCanty E, MacGilchrist C, Tawfick W, McIntosh C. Screening for Atrial Fibrillation in Community and Primary CareSettings: A Scoping Review. J Atr Fibrillation. 2021;13(5):2452.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDhutia H, Malhotra A, Finocchiaro G, Parpia S, Bhatia R, D\u0026rsquo;Silva A et al. Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol. 6 de agosto de. 2021;23(8):1295\u0026thinsp;\u0026ndash;\u0026thinsp;301.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRitchie LA, Penson PE, Akpan A, Lip GYH, Lane DA. Integrated Care for Atrial Fibrillation Management: The Role of the Pharmacist. Am J Med diciembre de. 2022;135(12):1410\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhurshid S, Choi SH, Weng LC, Wang EY, Trinquart L, Benjamin EJ, et al. Frequency of Cardiac Rhythm Abnormalities in a Half Million Adults. Circ Arrhythm Electrophysiol julio de. 2018;11(7):e006273.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJones NR, Taylor CJ, Hobbs FDR, Bowman L, Casadei B. Screening for atrial fibrillation: a call for evidence. Eur Heart J 7 de marzo de. 2020;41(10):1075\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstr\u0026ouml;m-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 1 de febrero de. 2021;42(5):373\u0026ndash;498.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBirkemeyer R, M\u0026uuml;ller A, Wahler S, von der Schulenburg JM. A cost-effectiveness analysis model of Preventicus atrial fibrillation screening from the point of view of statutory health insurance in Germany. Health Econ Rev 9 de junio de. 2020;10(1):16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDani\u0026euml;ls F, Ramdjan TTTK, M\u0026aacute;nfai B, Adiyaman A, Smit JJJ, Delnoy PPHM, et al. Detection of atrial fibrillation in persons aged 65 years and above using a mobile electrocardiogram device. Neth Heart J 1 de abril de. 2024;32(4):160\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFitzmaurice DA, Hobbs FDR, Jowett S, Mant J, Murray ET, Holder R, et al. Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ 25 de agosto de. 2007;335(7616):383.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorillas P, Pallar\u0026eacute;s V, Llisterri JL, Sanchis C, S\u0026aacute;nchez T, F\u0026aacute;cila L, et al. Prevalencia de fibrilaci\u0026oacute;n auricular y uso de f\u0026aacute;rmacos antitromb\u0026oacute;ticos en el paciente hipertenso\u0026thinsp;\u0026ge;\u0026thinsp;65 a\u0026ntilde;os. El registro FAPRES. Rev Esp Cardiol agosto de. 2010;63(8):943\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLabrador Garc\u0026iacute;a MS, Merino Segovia R, Jim\u0026eacute;nez Dom\u0026iacute;nguez C, Garc\u0026iacute;a Salvador Y, Segura Fragoso A, Hern\u0026aacute;ndez Lanchas C. Prevalencia de fibrilaci\u0026oacute;n auricular en mayores de 65 a\u0026ntilde;os de una zona de salud. Aten Primaria. 2001;28(10):648\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTveit A, Abdelnoor M, Enger S, Smith P. Atrial fibrillation and antithrombotic therapy in a 75-year-old population. Cardiology. 2008;109(4):258\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZiegler PD, Glotzer TV, Daoud EG, Singer DE, Ezekowitz MD, Hoyt RH et al. Detection of previously undiagnosed atrial fibrillation in patients with stroke risk factors and usefulness of continuous monitoring in primary stroke prevention. Am J Cardiol. 1 de noviembre de. 2012;110(9):1309-14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKakkar AK, Mueller I, Bassand JP, Fitzmaurice DA, Goldhaber SZ, Goto S, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS ONE. 2013;8(5):e63479.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrijthe BP, Kunst A, Benjamin EJ, Lip GYH, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J septiembre de. 2013;34(35):2746\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026oacute;mez-Doblas JJ, Mu\u0026ntilde;iz J, Martin JJA, Rodr\u0026iacute;guez-Roca G, Lobos JM, Awamleh P, et al. Prevalence of atrial fibrillation in Spain. OFRECE study results. Rev Esp Cardiol Engl Ed abril de. 2014;67(4):259\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLang\u0026eacute;n V, Winst\u0026eacute;n AK, Airaksinen KEJ, Teppo K. Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials. Ann Med. 57(1):2457522.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 29 de septiembre de. 2024;45(36):3314\u0026ndash;414.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlier K, Koch L, Graf L, Schink\u0026ouml;the T, Schmidt A. Diagnostic Accuracy of Single-Lead Electrocardiograms Using the Kardia Mobile App and the Apple Watch 4: Validation Study. JMIR Cardio. 23 de noviembre de 2023;7:e50701.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSavickas V, Stewart AJ, Short VJ, Mathie A, Bhamra SK, Veale EL, et al. Screening for atrial fibrillation in care homes using pulse palpation and the AliveCor Kardia Mobile\u0026reg; device: a comparative cross-sectional pilot study. Int J Clin Pharm 1 de abril de. 2024;46(2):529\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Atrial fibrillation, screening, community pharmacy","lastPublishedDoi":"10.21203/rs.3.rs-7262408/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7262408/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAtrial fibrillation (AF) is a common, often silent, arrhythmia that markedly increases stroke risk yet remains undiagnosed in many high-risk adults. Mobile electrocardiogram technology in community pharmacies has detected 1–5% new AF internationally, but real-world pharmacist-led data in Southern Europe are scarce.\u003c/p\u003e\n\u003cp\u003eOur study screened adults ≥55 years with cardiovascular risk factors in Spanish pharmacies to determine the frequency of undiagnosed AF and facilitate early stroke prevention.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods: \u003c/em\u003eA\u003cem\u003e \u003c/em\u003equasi-experimental multicenter cross-sectional study was conducted in Community Pharmacies, Health Centers and Auxiliary Clinics in the Basic Health Area of Sagunto and Puerto de Sagunto (Spain) between April and June 2024. Community pharmacy users aged 55 years or older, with at least one risk factor, were included: hypertension, diabetes, heart failure, coronary heart disease, chronic kidney disease, BMI \u0026gt;30 kg/m\u003csup\u003e2\u003c/sup\u003e, obstructive sleep apnea and who had signed the informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePrimary variable\u003c/em\u003e: 1-lead electrocardiogram (ECG) result.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults: \u003c/em\u003e784 users were included, with a mean age of 70.1 years (SD = 8.0). From the 62 (7.9%) users identified with an alteration in the 1-lead ECG, 36 (58.1%) corresponded to a possible AF. Of these, thirty-four were referred to the Health Centre for confirmation by 12-lead ECG. Six patients (17.6%) were diagnosed with AF.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions: \u003c/em\u003eopportunistic AF screening in community pharmacies, using portable technology, is a viable strategy to identify potential cases of undiagnosed AF in the at-risk population, contributing to early diagnosis of the arrhythmia and thus to stroke prevention.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTrial registration:\u003c/em\u003e Not applicable.\u003c/p\u003e","manuscriptTitle":"Screening for Undiagnosed Atrial Fibrillation in Community Pharmacies using mobile electrocardiogram technology: A Quasi-Experimental Cross- Sectional Study (PREVENIM ICTUS)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 06:42:07","doi":"10.21203/rs.3.rs-7262408/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-01T12:09:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-29T19:24:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92486772858307540248487272523350643245","date":"2025-11-11T06:53:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168977000279934415588689541233968576704","date":"2025-11-10T16:54:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-10T09:13:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137575662786135724208309792441550155167","date":"2025-11-09T20:17:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118619844591860266501418043341762741865","date":"2025-10-08T03:14:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-01T09:40:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-03T22:42:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-03T22:42:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-07-31T12:44:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"076cc491-2750-4a11-80f3-842e2d607a9a","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:02:52+00:00","versionOfRecord":{"articleIdentity":"rs-7262408","link":"https://doi.org/10.1186/s12875-026-03188-7","journal":{"identity":"bmc-primary-care","isVorOnly":false,"title":"BMC Primary Care"},"publishedOn":"2026-01-30 15:58:23","publishedOnDateReadable":"January 30th, 2026"},"versionCreatedAt":"2025-10-15 06:42:07","video":"","vorDoi":"10.1186/s12875-026-03188-7","vorDoiUrl":"https://doi.org/10.1186/s12875-026-03188-7","workflowStages":[]},"version":"v1","identity":"rs-7262408","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7262408","identity":"rs-7262408","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}