Echocardiography (ECHO) is the “gold standard” test in the diagnosis of heart failure. Brain natriuretic peptide (BNP) can be helpful to rule outpatients who do not require ECHO. This study used an elevated level of Nterminal prohormone BNP (NT-proBNP) as a criterion for referral to a new community heart failure clinic. Results showed that NT-proBNP could be a useful test in the management of heart failure. The researchers propose to institute age- and sex-related cut-offs to refine its place in the patient care pathway.
How can we avoid a stroke crisis?
A report from a multidisciplinary alliance has made a compelling case for a coordinated planin Europe to reduce the health, social and economic burdens of stroke related to atrialfibrillation (AF). The group comprises eminent cardiologists, neurologists, a healtheconomists, hospital pharmacists, a haematologist and representatives from patientorganisations.How Can We Avoid a Stroke Crisis? has been endorsed by 17 medical and patientorganisations, including the European Primary Care Cardiovascular Society. Its aim is tohighlight to European policy makers the need to achieve earlier diagnosis and bettermanagement of AF across Europe, with the ultimate goal of reducing the risk of stroke inpatients with AF. The key points summarised in the report are shown in table 1.
Atrial Fibrillation In Primary care: Bringing practice closer to guidelines – a tool for primary care physicians
In the last few years we have witnessed a number of advances in the management of atrial fibrillation (AF). While these have created valuable opportunities to improve patient outcomes, we need to ensure physicians have the right support to deliver the most appropriate care. The AF AWARE (Atrial Fibrillation AWareness And Risk Education) campaign, working with a panel of AF experts, has developed the Atrial Fibrillation in Primary care (AFIP) tool – a ‘go to’ resource for primary care physicians, to help with the identification and management of AF, in line with the latest published guidelines. This article provides some background to the need for such a tool, and an outline of its content.
CT coronary calcium scoring: improving cardiac risk stratification
We describe the technique, application, risks and benefits of computed tomography (CT) coronary calcium scoring in relation to how it could be used in primary care to help produce an individualised cardiac risk assessment.
Give me sunshine: vitamin D and cardiovascular health
Vitamin D deficiency is a prevalent and important health issue that warrants vigilant systematic screening and appropriate treatment and follow-up on the part of physicians,especially those in the primary care and cardiovascular fields. In this article we review the sources and metabolism of vitamin D, the epidemiology of vitamin D deficiency, and the available evidence linking vitamin D deficiency to cardiovascular disease; and we suggest an approach to systematic screening and to treatment of vitamin D deficiency.
Current evidence for the management and early treatment of transient ischaemic attack
Transient ischaemic attack (TIA) is an important risk factor for stroke. Early recognition of symptoms and timely secondary prevention significantly reduce stroke risk. We review current evidence and guidelines for early management and treatment of TIA, including early antiplatelet therapy, specialist review, and recognition and treatment of other risk factors. The roles of carotid artery and brain imaging are also considered.
Vitamin D and cardiovascular health
Vitamin D deficiency is a prevalent and important health issue that warrants vigilant systematic screening and appropriate treatment and follow-up on the part of physicians, especially those in the primary care and cardiovascular fields. Although vitamin D deficiency has traditionally been associated primarily with bone disease, it is now clear that this is a multi-organ system disease. Epidemiological studies consistently show strong associations between vitamin D deficiency and bone disease, cancer and diabetes. Additionally, epidemiological evidence links vitamin D deficiency with cardiovascular risk factors, cardiovascular disease and mortality. Conclusive evidence to show that vitamin D supplementation improves cardiovascular prognosis is currently lacking, although randomised trials are under way to address this issue. In this article we review the sources and metabolism of vitamin D, the epidemiology of vitamin D deficiency, and the available evidence linking vitamin D deficiency to cardiovascular disease; and we suggest an approach to systematic screening and to treatment of vitamin D deficiency.
Understanding the impact of statin titration: a modelling approach
Introduction: Clinical guidelines specifying target cholesterol levels may require dose titration strategies for patients who do not reach target. We describe a model that simulates cholesterol and cardiovascular risk reductions for different populations, therapies, titration steps and targets.
Looking back, looking forward: reflecting on the winter season and the demise of the PCCS
The message regarding eating less has come across loud and clear this year, but there has been plenty to worry about over the last twelve months. The demise of the Primary Care Cardiovascular Society (PCCS) has been on my mind. I was saddened to attend an Extraordinary General Meeting in January 2012, when it was decided to wind up the Society with honour due to declining funds and concern that this situation was likely to deteriorate for the foreseeable future. The closure of the PCCS is a great blow to all of us interested in promoting and improving the prevention and management of cardiovascular disease in our communities.
EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 2010
Keeping on track for good concordance with CVD and diabetes drugs
What is important when a nurse and patient are together in a consultation? Most of us have had consultations where the discussion did not appear to achieve anything, while, on other occasions, both parties seemed to be working well together. This article looks at how to share the process of planning treatment with a patient to improve health outcomes; it examines what concordance is, and how to achieve it, looking at how this might work out in practice.
Managing patients with recent onset chest pain: key steps
Chest pain and discomfort are common symptoms that account for 1% of visits to primary care, 5% of visits to accident and emergency departments and 25% of emergency hospital admissions. Coronary artery disease (CAD) is one of many causes of chest pain and is the commonest cause of death in the UK. However, there are treatments available that can improve symptoms and prolong life, making prompt assessment and diagnosis essential. The National Institute for Health and Clinical Excellence (NICE) has recently published a new guideline on the assessment and investigation of patients presenting with acute chest pain suggestive of acute coronary syndrome (ACS) and stable chest pain suggestive of angina. It includes recommendations that will mean some changes to the way these patients are managed in practice. This article looks at how we can put these changes into action.
