In the ever-evolving landscape of community pharmacy, the proactive detection of health conditions plays a pivotal role in improving patient outcomes. The successful implementation of a proactive approach to detect Hypertensive Heart Disease (HVD) in a community pharmacy setting, can showcase such positive impact on patient well-being.

A Farnborough-based community pharmacy has engaged in a proof-of-concept evaluation with the objective of assessing the viability of utilizing digital auscultation by a community pharmacist for the early detection of heart valve disease (HVD). The primary focus of this evaluation was to determine whether this approach could serve as an effective entry point into the HVD pathway, facilitating timely diagnosis and treatment for individuals exhibiting potential symptoms.

The service evaluation, initiated within the Farnborough Primary Care Network (PCN), conducted a comparative analysis between the community pharmacy pathway and the standard GP auscultation and referral pathway within the same PCN. This evaluation, spanning six months from its launch in June 2022, aimed to assess the effectiveness of the community pharmacy pathway. James Martin, a pharmacist at Chapel Pharmacy, underwent training to utilize an e-stethoscope equipped with artificial intelligence (AI) software designed to enhance murmur detection during the evaluation period.

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Who are eligible? 

The proactive approach was tailored to include all individuals aged 75 and above, as well as those with hypertension, type 2 diabetes, ischemic heart disease, or atrial fibrillation who visited the pharmacy. Moreover, walk-in patients exhibiting symptoms suggestive of Hypertensive Heart Disease (HVD) were also considered eligible to receive the benefits of the service.

The patients that are eligible for the service will receive a leaflet outlining the offering, supplemented by either face-to-face interactions or subsequent telephone calls. Such cases where a murmur was identified during the auscultation appointment, a digital referral is promptly sent to the community echocardiography service, with a copy sent to the patient's GP. The echocardiography service then evaluated and categorized patients into three groups: normal, trivial, mild, or moderate/severe Hypertensive Heart Disease (HVD). For cases where no murmur was detected during auscultation, GPs then were informed that the patient had undergone the test.

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Based on the published Outcomes and Potential Impact:

A total of 86 patients underwent digital auscultation within the community pharmacy. Notably, 39 patients (45%) were identified as having murmurs, leading to their subsequent referral to echocardiography. In comparison, GPs in the Primary Care Network (PCN) area, using manual auscultation, made 24 referrals to echocardiography for suspected murmurs during the same period. Unfortunately, the total number of patients auscultated by GPs within the specified period is currently unknown.

Overall, the outcomes highlight the potential positive impact and benefits of digital auscultation in the community pharmacy setting, showcasing higher detection rates and potential efficiency in referring patients for echocardiography. Further research and data collection could provide additional insights and more nuanced understanding into the implications for patient care and healthcare resource management.

There is a clear significance on the ability of the community pharmacist to identify more cases of mild or moderate/severe HVD is clinically significant, as it may lead to early intervention and management for patients with potentially more advanced conditions. This highlights the community pharmacy's potential pivotal role in early detection and management of cardiovascular conditions, underscoring its significance in contributing to proactive healthcare interventions.

Although both the community pharmacy and general practices identified a comparable number of patients with normal or trivial Heart Valve Disease (HVD), general practices had a higher percentage of patients with mild HVD. When excluding patients with normal or trivial HVD, the community pharmacist detected 70% more patients with mild or moderate/severe HVD compared to general practices (17 patients versus 10 patients).

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Sample referral Data: Source from Community Pharmacy England

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Deborah Crockford, former Chief Officer of Community Pharmacy South Central, expressed her enthusiasm, stating, "It is thrilling and gratifying to witness how new technologies, coupled with the distinct skills and qualities of community pharmacy, can be leveraged to enhance healthcare provision within a collaborative system. Lives have been saved and enhanced, contributing to a sustained reduction in costs for the NHS."

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James Martin, Pharmacist at Chapel Pharmacy, shared his insights, stating:

“The community pharmacy heart valve detection pilot was a unique opportunity to truly demonstrate the value of community pharmacy. Often, as a profession, we say we are the most accessible service for patients (although with recent pharmacy closures and underfunding this is becoming increasingly difficult) and this service exemplified this.

“Embracing new technologies, and collaborative working with other healthcare professionals allowed us to opportunistically auscultate over 80 patients and to detect a murmur in just under 50% of these patients. These patients were then referred to a GP with special interest, where they had an ultrasound. 50% of these referred patients had a moderate to severe condition and were started on treatment, hopefully preventing any worsening of their condition over the years to come.

“In one case, a symptomatic patient came in, I was able to successfully auscultate them and the A.I detected a murmur, due to my concerns I called the GP with special interests who was able to immediately log into the auscultation portal and listen to the recording. The GP then advised I send the patient to A&E with a copy of the report, the patient was then subsequently referred for a valve replacement.

“The potential value of this service is immense, both to patients and the NHS. Increasing the detection rate of valve disease at an early stage will increase the quality of life of millions of patients and reduce the burden not just on GPs but on the NHS. Embracing digital technology, and collaborative working with general practice is the future of pharmacy and it is exciting to be a part of this change.”

It is indeed a service that holds a tremendous significant potential, benefiting both patients and the NHS. Enhancing the early-stage detection rate of valve disease has the potential to improve the quality of life for millions of patients while alleviating the workload not only for GPs but also for the NHS. The evolution of pharmacy is rooted in the integration of digital technology and the cultivation of collaborative partnerships with general practice. Being an integral part of this transformative shift is genuinely exhilarating.