Pharmacy-based Opportunistic Screening for Atrial Fibrillation Using a Portable ECG Device Integrated With Emergency Medical Services: a Prospective Type-1 Hybrid Implementation Study (NUMAPLUS Project)

STUDY DESIGN This is a prospective, single-cohort, type-1 effectiveness-implementation hybrid study conducted within the NUMAPLUS project (INTERREG VI-A España-Portugal, POCTEP 2021-2027, co-financed by the European Regional Development Fund). This design was selected because external evidence on the diagnostic accuracy of the Kardias® device is sufficient to justify its deployment, while uncertainty persists regarding the organisational conditions, care pathways and economic incentives required for its sustainable integration into the Andalusian community pharmacy network. The primary focus is on implementation outcomes; clinical outcomes related to atrial fibrillation screening are collected as secondary endpoints. The study is reported in accordance with the Standards for Reporting Implementation Studies (StaRI) guideline.

SETTING The study is conducted in 38 community pharmacies in the province of Seville affiliated with the Real e Ilustre Colegio Oficial de Farmacéuticos de Sevilla (RICOFS), selected by voluntary participation following an open invitation. Eligibility criteria for pharmacies required stable internet connectivity for access to the Numaplus application, completion of pre-study training, and absence of concurrent participation in another cardiovascular screening programme. Priority was given to pharmacies with 24-hour or 12-hour opening schedules. Geographic coverage targets at least three urban health zones per province and at least one semi-urban or rural zone per healthcare management area.

The study articulates three coordination levels: (1) the community pharmacy as the point of patient recruitment and screening; (2) Salud Responde (CES 061) as the clinical validation, risk stratification and real-time coordination node; and (3) the primary care physician as the responsible party for definitive diagnosis and initiation of treatment.

TRAINING OF PARTICIPATING PHARMACISTS Prior to the recruitment period, all enrolled pharmacists completed a structured training programme accredited by the Escuela Andaluza de Salud Pública (EASP) and the Agencia de Calidad Sanitaria de Andalucía (ACSA). The programme was delivered entirely online in asynchronous modality between 23 March and 13 April 2026 (10 hours total) through the EASP Moodle platform. It comprised four learning units: (1) epidemiological basis and scientific rationale for opportunistic AF screening; (2) detection protocol, radial pulse palpation technique, and interpretation of Kardias® device outputs; (3) data entry in the Numaplus platform, risk classification and patient communication within the pharmacy-Salud Responde circuit; and (4) ethical and legal framework, informed consent procedures, and data protection requirements. Certification required completion of all practical activities and a minimum score of 7 out of 10 on the final knowledge assessment.

INTERVENTION