Atrial fibrillation (AF) accounts for up to one third of strokes, one of the lead mortality causes worldwide. The European Society of Cardiology guidelines recommend opportunistic screening as a means to increase the odds of early detection and institution of appropriate treatment according to risk factors identified. However, in most countries there are various barriers to effective uptake of screening, including low awareness. The Atrial Fibrillation Association is a patient association engaged with raising awareness of AF. Establishing a partnership with the International Pharmacists for Anticoagulation Care Taskforce, we set as goals to test a model for raising awareness of AF involving pharmacists globally; and to identify barriers and enablers to its implementation. A cross-sectional study was conducted during the Arrhythmia Alliance World Heart Rhythm Week. Pharmacists from 10 countries invited individuals (≥ 40 years; without anticoagulation therapy of AF) to participate in the awareness campaign. Participants agreeing were engaged in the early detection of AF (EDAF) using pulse palpation. Individuals with rhythm discrepancies were referred and prospectively assessed to have information on the proportion of confirmed diagnosis, leading to estimate the detection rate. Interviews with country coordinators explored barriers and enablers to implementation. The study involved 4193 participants in the awareness campaign and 2762 in the EDAF event (mean age 65.3 ± 13.0), of whom 46.2% individuals were asymptomatic, recruited across 120 sites. Most common CHA2DS2-VASc risk factor was hypertension. Among 161 patients referred to physician, feedback was obtained for 32 cases, of whom 12 new arrhythmia diagnoses were confirmed (5 for AF, 2 for atrial flutter), all among elders (≥ 65 years). Qualitative evaluation suggested a local champion to enable pharmacists' success; technology enhanced engagement amongst patients and increased pharmacists' confidence in referring to physicians; interprofessional relationship was crucial in success. This study suggests pharmacists can contribute to greater outreach of awareness campaigns. Effective communication pathways for inter-professional collaboration were suggested enablers to gain full benefits of EDAF.

Atrial Fibrillation Association AF Association Unit 6B Essex House Cromwell Business Park Chipping Norton Oxfordshire OX7 5SR UK

Barts Health NHS Trust UCL Partners 9 Prescot Street Aldgate London E1 8PR UK

Centre for Learning Enhancement and Research The Chinese University of Hong Kong Shatin Hong Kong

Centro de Investigação Interdisciplinar Egas Moniz Campus Universitário Quinta da Granja Monte da Caparica 2829 511 Caparica Portugal

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Kralove Charles University Akademika Heyrovského 1203 8 500 05 Hradec Kralove Czech Republic

Faculdade de Farmácia The Research Institute for Medicines Universidade de Lisboa Lisbon Portugal

Faculté de Pharmacie Hôpital Antoine Béclère Université Paris Sud 157 Rue de la Porte de Trivaux 92140 Clamart France

Faculty of Pharmacy University of Szeged Zrínyi u 9 Szeged 6720 Hungary

Farmácia Nuno Álvares Avenida D Nuno Álvares Pereira 39 C Almada Portugal

Heart Research Institute Charles Perkins Centre University of Sydney John Hopkins Dr Camperdown NSW Sydney 2006 Australia

Leslie Dan Faculty of Pharmacy University of Toronto 144 College St Toronto ON M5S 3M2 Canada

Pharmaceutical Care Research Group University of Basel Pharmazentrum Klingelbergstrasse 50 4056 Basel Switzerland

School of Health and Social Care Edinburgh Napier University Sighthil Campus Sighthill Court Edinburgh EH11 4BN Scotland UK

Sociedad Española de Farmacia Familiar y Comunitaria SEFAC Travessera de Gràcia 56 08006 Barcelona Spain

Westview Pharmacy 5 Glendale Road Glen Eden Auckland 0602 New Zealand

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