Feasibility of cardiovascular risk screening in Portuguese community pharmacies

Keywords: Heart Disease Risk Factors, Cardiovascular Diseases, Risk Factors, Risk Assessment, Pharmacies, Pharmaceutical Services, Pharmacists, Sedentary Behavior, Dyslipidemias, Hypertension, Obesity, Smoking, Feasibility Studies, Cross-Sectional Studies, Portugal


Background: Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs.

Objective: To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability.

Methods: A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants’ data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines.

Results: Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD.

Conclusions: We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.


Download data is not yet available.


Ritchie H, Roser M. Causes of Death. Our World in Data - 2019. https://ourworldindata.org/causes-of-death (accessed Dec 20, 2020).

Pereira M, Azevedo A, Lunet N, et al. Explaining the decline in coronary heart disease mortality in Portugal between 1995 and 2008. Circ Cardiovasc Qual Outcomes. 2013;6(6):634-642. https://doi.org/10.1161/circoutcomes.113.000264

Instituto Nacional de Estatística. [Health statistics – 2018]. Lisboa: INE; 2020.

Direção-Geral da Saúde. [National Programme of Prevention and Control of the Cardiovascular Diseases]. Lisboa: DGS; 2006.

Direção-Geral da Saúde. [National Program for the Cardio and Cerebrovascular Diseases]. Lisboa: DGS; 2017.

Bovet P, Chiolero A, Paccaud F, Banatvala N. Screening for cardiovascular disease risk and subsequent management in low and middle income countries: challenges and opportunities. Public Health Rev. 2015;36:13. https://doi.org/10.1186/s40985-015-0013-0

Rocha E, Nogueira P. Cardiovascular diseases in Portugal and in the Mediterranean region: an epidemiological perspective. Rev Factores Risco. 2015;36:35-44.

Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952. https://doi.org/10.1016/s0140-6736(04)17018-9

Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention assessment. Ann Intern Med. 1993;119(12):1187-1197. https://doi.org/10.7326/0003-4819-119-12-199312150-00006

Santos P. The Role of Cardiovascular Risk Assessment in Preventive Medicine: A Perspective from Portugal Primary Health-Care Cardiovascular Risk Assessment. J Environ Public Health. 2020;2020:1639634. https://doi.org/10.1155/2020/1639634

World Health Organizatioln; World Heart Federation; World Stroke Organization. Global atlas on cardiovascular disease prevention and control. http://apps.who.int/iris/bitstream/10665/44701/1/9789241564373_eng.pdf?ua=1 (accessed Dec 20, 2020).

Lee H, Prentice D. Early identification of cardiovascular risk factors in adolescents and follow-up intervention strategies. https://www.intechopen.com/books/cardiovascular-risk-factors/early-identification-of-cardiovascular-risk-factors-in-adolescents-and-follow-up-intervention-strate (accessed Dec 20, 2020).

Sierra C, de la Sierra A. Early detection and management of the high-risk patient with elevated blood pressure. Vasc Health Risk Manag. 2008;4(2):289-296. https://doi.org/10.2147/vhrm.s930

Carter M, Karwalajtys T, Chambers L, et al. Implementing a standardized community-based cardiovascular risk assessment program in 20 Ontario communities. Health Promot Int. 2009;24(4):325-333. https://doi.org/10.1093/heapro/dap030

Sabater-Hernández D, Sierra A de la, Bellver-Monzó O, et al. Action guide for community pharmacist in patients with hypertension and cardiovascular risk. Consensus Document. Ars Pharm. 2011;52(2):38-58.

Ministério da Saúde. [First amendment to Directive 1429/2007, that defines the services provided by pharmacies. Portugal]. https://data.dre.pt/eli/port/97/2018/04/09/p/dre/pt/html (accessed Dec 20, 2020).

Ribeiro N, Mota-Filipe H, Guerreiro MP, Costa FA. Primary health care policy and vision for community pharmacy and pharmacists in Portugal. Pharm Pract (Granada). 2020;18(3):2043. https://doi.org/10.18549/pharmpract.2020.3.2043

van Mil JW, Schulz M, Tromp TF. Pharmaceutical care, European developments in concepts, implementation, teaching, and research: a review. Pharm World Sci. 2004;26(6):303-311. https://doi.org/10.1007/s11096-004-2849-0

O'Loughlin J, Masson P, Déry V, Fagnan D. The role of community pharmacists in health education and disease prevention: a survey of their interests and needs in relation to cardiovascular disease. Prev Med. 1999;28(3):324-331. https://doi.org/10.1006/pmed.1998.0436

Horgan JM, Blenkinsopp A, McManus RJ. Evaluation of a cardiovascular disease opportunistic risk assessment pilot ('Heart MOT' service) in community pharmacies. J Public Health (Oxf). 2010;32(1):110-116. https://doi.org/10.1093/pubmed/fdp092

George J, McNamara K, Stewart K. The roles of community pharmacists in cardiovascular disease prevention and management. Australas Med J. 2011;4(5):266-272. https://doi.org/10.4066/amj.2011.698

Tsuyuki RT, Al Hamarneh YN, Jones CA, Hemmelgarn BR. The Effectiveness of Pharmacist Interventions on Cardiovascular Risk: The Multicenter Randomized Controlled RxEACH Trial. J Am Coll Cardiol. 2016;67(24):2846-2854. https://doi.org/10.1016/j.jacc.2016.03.528

Corlett SA, Krska J. Evaluation of NHS Health Checks provided by community pharmacies. J Public Health (Oxf). 2016;38(4):e516-e523. https://doi.org/10.1093/pubmed/fdv153

Al Harmarneh YN, Lamb S, Donald M, et al. Pharmacist prescribing and care improves cardiovascular risk, but what do patients think? A substudy of the RxEACH study. Can Pharm J (Ott). 2018;151(4):223-227. https://doi.org/10.1177/1715163518779092

Willis A, Rivers P, Gray LJ, Davies M, Khunti K. The effectiveness of screening for diabetes and cardiovascular disease risk factors in a community pharmacy setting. PLoS One. 2014;9(4):e91157. https://doi.org/10.1371/journal.pone.0091157

Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved?. Integr Pharm Res Pract. 2019;8:1-11. https://doi.org/10.2147/iprp.s133088

Kaczorowski J, Chambers LW, Dolovich L, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ. 2011;342:d442. https://doi.org/10.1136/bmj.d442

Jahangard-Rafsanjani Z, Hakimzadeh N, Sarayani A, et al. A community pharmacy-based cardiovascular risk screening service implemented in Iran. Pharm Pract (Granada). 2017;15(2):919. https://doi.org/10.18549/pharmpract.2017.02.919

Guerreiro M, Cantrill J, Martins P. Acceptability of community pharmaceutical care in Portugal: a qualitative study. J Health Serv Res Policy. 2010;15(4):215-222. https://doi.org/10.1258/jhsrp.2010.009121

Petter J, Reitsma-van Rooijen MM, Korevaar JC, Nielen MM. Willingness to participate in prevention programs for cardiometabolic diseases. BMC Public Health. 2015;15:44. https://doi.org/10.1186/s12889-015-1379-0

Dryden R, Williams B, McCowan C, Themessl-Huber M. What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Public Health. 2012;12:723. https://doi.org/10.1186/1471-2458-12-723

Steckowych K, Smith M, Spiggle S, Stevens A, Li H. Building the Case: Changing Consumer Perceptions of the Value of Expanded Community Pharmacist Services. J Pharm Pract. 2019;32(6):637-647. https://doi.org/10.1177/0897190018771521

Boubon M, Alves AC, Rato Q. Prevalência de Fatores de Risco Cardiovascular Na População Portuguesa, http://www.insa.min-saude.pt/wp-content/uploads/2020/02/e_COR_relatorio.pdf (accessed Dec 20, 2020).

Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-2381. https://doi.org/10.1093/eurheartj/ehw106

Cooney MT, Selmer R, Lindman A, et al. Cardiovascular risk estimation in older persons: SCORE O.P. Eur J Prev Cardiol. 2016;23(10):1093-1103. https://doi.org/10.1177/2047487315588390

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1(Suppl 1):S62-S69. https://doi.org/10.2337/dc10-s062

Hindi AMK, Schafheutle EI, Jacobs S. Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review. Health Expect. 2018;21(2):409-428. https://doi.org/10.1111/hex.12639

Lindsey L, Husband A, Steed L, Walton R, Todd A. Helpful advice and hidden expertize: pharmacy users' experiences of community pharmacy accessibility. J Public Health (Oxf). 2017;39(3):609-615. https://doi.org/10.1093/pubmed/fdw089

Boardman H, Lewis M, Croft P, Trinder P, Rajaratnam G. Use of community pharmacies: a population-based survey. J Public Health (Oxf). 2005;27(3):254-262. https://doi.org/10.1093/pubmed/fdi032

Anderson C, Thornley T. "It's easier in pharmacy": why some patients prefer to pay for flu jabs rather than use the National Health Service. BMC Health Serv Res. 2014;14:35. https://doi.org/10.1186/1472-6963-14-35

Imfeld-Isenegger TL, Soares IB, Makovec UN, et al. Community pharmacist-led medication review procedures across Europe: Characterization, implementation and remuneration. Res Social Adm Pharm. 2020;16(8):1057-1066. https://doi.org/10.1016/j.sapharm.2019.11.002

Soares IB, Imfeld-Isenegger TL, Makovec UN, et al. A survey to assess the availability, implementation rate and remuneration of pharmacist-led cognitive services throughout Europe. Res Social Adm Pharm. 2020;16(1):41-47. https://doi.org/10.1016/j.sapharm.2019.02.002

Rodgers RM, Gammie SM, Loo RL, Corlett SA, Krska J. Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England. Patient Prefer Adherence. 2016;10:1749-1758. https://doi.org/10.2147/ppa.s112931

Famiyeh IM, MacKeigan L, Thompson A, Kuluski K, McCarthy LM. Exploring pharmacy service users' support for and willingness to use community pharmacist prescribing services. Res Social Adm Pharm. 2019;15(5):575-583. https://doi.org/10.1016/j.sapharm.2018.07.016

Wood K, Gibson F, Radley A, Williams B. Pharmaceutical care of older people: what do older people want from community pharmacy?. Int J Pharm Pract. 2015;23(2):121-130. https://doi.org/10.1111/ijpp.12127

Saramunee K, Krska J, Mackridge A, Richards J, Suttajit S, Phillips-Howard P. General public's views on pharmacy public health services: current situation and opportunities in the future. Public Health. 2015;129(6):705-715. https://doi.org/10.1016/j.puhe.2015.04.002

Fitzgerald N, Youngson E, Cunningham S, Watson M, Stewart D. Support for community pharmacy-based alcohol interventions: a Scottish general public survey. Public Health. 2015;129(11):1431-1438. https://doi.org/10.1016/j.puhe.2015.07.005

Cooper RJ, Tsoneva J. Benefits and tensions in delivering public health in community pharmacies - a qualitative study of healthy living pharmacy staff champions. Int J Pharm Pract. 2017;25(5):351-357. https://doi.org/10.1111/ijpp.12323

Taylor J, Krska J, Mackridge A. A community pharmacy-based cardiovascular screening service: views of service users and the public. Int J Pharm Pract. 2012;20(5):277-284. https://doi.org/10.1111/j.2042-7174.2012.00190.x

Brito AM, Simões AM, Alcobia A, Alves da Costa F. Optimising patient safety using pharmaceutical intervention in domiciliary hospitalization. Int J Clin Pharm. 2017;39(5):980-984. https://doi.org/10.1007/s11096-017-0512-9

de Oliveira Martins S, Serra e Silva P, Papoila AL, Caramona M, Foppe van Mil JW, Cabrita J. Assessment of global cardiovascular risk and risk factors in Portugal according to the SCORE® model. J Public Health (Bangkok). 2008;16(5):361-367. https://doi.org/10.1007/s10389-008-0183-z

How to Cite
Fonseca AA, Lima TM, Castel-Branco M, Figueiredo IV. Feasibility of cardiovascular risk screening in Portuguese community pharmacies. Pharm Pract (Granada) [Internet]. 2021May25 [cited 2021Jun.15];19(2):2255. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/2255
Original Research

Most read articles by the same author(s)