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Prevention is all the rage and non-one is better at stopping cardiovascular disease before it starts than independent pharmacists and their teams, as Victoria Goldman explains…

According to the British Heart Foundation in June 2025, the nation’s heart health declined more quickly at the start of the 2020s than in any other decade for over 50 years.

Since 2020, the latest UK figures show a 21 per cent rise in the number of people diagnosed with heart failure, a 10 per cent rise in the number of people diagnosed with atrial fibrillation, and an 82 per cent increase in the NHS cardiovascular waiting list in England. Cardiac waiting lists have also grown in Scotland, Wales, and Northern Ireland.

In October 2024, the NHS Confederation’s Paving a new pathway to prevention report explored the impact of certain cardiovascular prevention interventions by assessing their return on investment (ROI).

The primary preventions included smoking cessation, weight management and exercise, secondary preventions included managing diabetes and other chronic health conditions, and social determinants of health that can increase the risk of cardiovascular disease included housing and substance abuse.

The report’s findings highlighted that community pharmacies provided the highest ROI among community-based interventions, as well as the quickest (within one year). The pharmacy role includes improving cardiovascular medication adherence. NHS Health Checks and prescribing medicines such as statins with or without anticoagulants also offered high returns.

“Community pharmacies play a vital role in helping people take control of their heart health,” says Kate Wilderspin, health partnerships manager at British Heart Foundation.

“Pharmacists are often the most accessible healthcare professionals in a community, so they’re well placed to offer free blood pressure checks, lifestyle advice, support the safe use of medicines like statins and blood pressure treatments, and help people understand their cardiovascular risk.”

Blood pressure checks

According to the British Heart Foundation in July 2025, over 125,000 heart attacks and strokes could be prevented in the coming decade by finding and treating the millions of people with undiagnosed high blood pressure in the UK, alongside improving treatment for those already diagnosed with high blood pressure and cardiovascular disease.

The NHS Community Pharmacy Hypertension Case-Finding Advanced Service plays an important role in identifying new cases.

“The most effective way to carry out blood pressure checks and cholesterol checks is when people come into the pharmacy to pick up their medication,” says Clare Woodford, head of policy and influencing at the Stroke Association.

“Opportunistic screening is more of a challenge. Busy people who aren’t necessarily experiencing symptoms are less likely to come to their community pharmacy to get checked – and will go to their GP if necessary. More awareness raising the importance of these checks is needed to embed the message that they are vital preventative measures.”

Atrial fibrillation detection isn’t part of the Community Pharmacy Hypertension Case-Finding Advanced Service, and there is currently no NHS programme for the early detection or screening of this condition.

Recent randomised-controlled trials have found that opportunistic screening doesn’t increase the detection rates for atrial fibrillation compared with routine care in contemporary practice.

However, many people in the UK with this condition, which significantly increases stroke risk, remain undiagnosed.

“A simple pulse check taking less than one minute can detect the irregular heart rhythm,” says Trudie C.A. Lobban MCE, founder of the Arrhythmia Alliance and AF Association.

“Someone complaining to their pharmacist of a racing heart, palpitations, light-headedness etc. should alert pharmacists to offer to check the rhythm of their heart and, if irregular, encourage them to seek a diagnosis from their GP. With apps such as Kardia Mobile, customers can easily check their own heart rhythm whilst waiting for their prescription.”

Expanding services

At the end of October 2024, the Alliance for Heart Failure pitched the pilot of a Heart Failure Case-Finding Service as an addition to the existing Hypertension Service in pharmacies.

According to the Alliance, community pharmacists play a vital role for people with heart failure, through early diagnosis and the optimisation of medicines, yet they are under-resourced and undeveloped.

Preeti Minhas, co-chair of the Alliance for Heart Failure, says that there is clear potential for community pharmacists to support earlier detection by identifying suspected cases and referring patients to their GP, as well optimising medication.

“Simple additions to existing hypertension checks – such as asking about breathlessness, fatigue or ankle swelling – could help detect and diagnose heart failure earlier, ensuring people receive the right treatment as quickly as possible,” she says.

“A community pharmacist in Bridlington has successfully developed a business case for his service. By working in partnership with his local heart failure team, he has increased optimisation of the four key drug classes – angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter-2 (SGLT2) inhibitors – from just five per cent to 24 per cent in his area.”

Funding is currently a major barrier to improving cardiovascular care through community pharmacies. “Pharmacists have to follow the funding, unfortunately,” says Lindsey Fairbrother, superintendent pharmacist at the Good Life Pharmacy in Hatton, Derbyshire.

“Most of the funded activity is in people who haven’t yet been diagnosed with a cardiovascular condition, such as the Hypertension Service. In people with existing conditions, the only funded service is the New Medicine Service (NMS) for those on new cardiovascular drugs.

“Pharmacists could be doing a lot more – we often get asked to carry out medication reviews, for example – but pharmacists don’t receive the funding to spend time on this.”

Hard-to-reach groups

According to the Bridging Hearts report by the British Heart Foundation in April 2025, addressing health inequalities will be a critical part of recovering lost momentum when it comes to driving down rates of cardiovascular disease. Bridging Hearts highlights that, in every UK nation, the most deprived people are at greater risk of dying prematurely from heart disease.

Alwyn Fortune, community pharmacist and RPS policy and engagement lead in Wales, says that community pharmacies could offer blood pressure checks in community settings to reach more at-risk groups.

“They can help to reach people who may not otherwise access healthcare, such as those affected by homelessness, addiction or mental health challenges,” he says.

“By working in partnership with local charities and social care and support services, pharmacies can engage these groups to provide cardiovascular health checks and advice.”

Fairbrother says that she has obtained public health funding to go on-site among the local traveller community, including offering blood pressure checks for the over-40s as part of the Hypertension Service.

“The traveller community doesn’t often seek medical help, so we have taken time to build up trust,” she says. “Drug addicts are another important high-risk group – but many are in their 20s and 30, which means, since we are not getting paid, we can’t afford to offer them free blood pressure checks.”