Aortic stenosis (AS) is the commonest cardiac valve disease in developed countries, with aortic sclerosis affecting 26% of people aged 65 and over and severe AS occurring in 3% of people over 75 years. It will become more prevalent with the ageing population. Symptoms include dyspnoea and chest pain, but these are often missed so many patients are currently undiagnosed. Once symptoms occur, prognosis is poor, with average survival being only two to three years.Aortic valve replacement is the only effective treatment for severe, symptomatic AS and is recommended in both European and US guidelines, but many older patients with co-morbidities are currently considered unsuitable or too high-risk for open-heart surgery. The development of transcatheter aortic valve implantation (TAVI) offers an effective treatment option for these patients. Latest figures show the number of patients undergoing TAVI in the UK is below that recommended by the National Institute for Health and Clinical Excellence (NICE) and the rate in other European countries, indicating scope for increased referrals and use of this procedure to improve outcomes.
EDUCATIONAL SERIES ON HDL-C | Targeting low HDL cholesterol: why, who and how
The new coalition government of the United Kingdom (UK) has announced plans to change the NHS radically in England. The Department of Health has published two important documents – Equity and excellence: liberating the NHS and Liberating the NHS: commissioning for patients. The implications for primary and secondary care, and for local authorities, mental health services and community providers, will be enormous. The changes are taking place at a rapid pace and every manager and clinician in the NHS will need to keep abreast of developments as they will affect the way in which we all deliver services in the future.
Screening for peripheral arterial disease: a real chance to improve patient care
Symptomatic peripheral arterial disease (PAD) affects 3-5% of the population over 60 years of age. Many patients with PAD are unaware of their diagnosis, and hence may not have mentionedthe classical symptoms to their GP. The Edinburgh questionnaire is a validated tool thathelps identify susceptible patients. The questionnaire was administered to patients routinelyattending annual influenza immunisation clinics, in order to identify patients potentially at risk ofPAD. In all, 2.9% of the >65yr cohort were identified by the questionnaire as at risk of PAD.Opportunity was made for these patients to have their risk factors reviewed, and managementwas adjusted in line with the Target PAD algorithm. Reducing the risk factor profile of suchpatients improves quality of life scores, morbidity, and mortality. Periodic screening of an ‘atrisk’population may identify individuals who would gain considerable benefit from furtherevidence-based management.
Broken heart syndrome (Takotsubo cardiomyopathy)
Breathing new life into managing patients with chronic obstructive pulmonary disease and cardiovascular disease
Chronic clinical conditions have traditionally been regarded as individual disease categories within individual patients, although there is often considerable overlap across clinical systems. However, for those managing these patients the presence of various co-morbidities is all-too apparent. It may be time to consider a new approach to management of these patients.
Cardiovascular morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) is nearly double the rate in the general population without COPD. And for those with cardiovascular disease (CVD) and COPD, heart failure is the most common cause of hospitalisation.
What do the new QOF indicators mean for primary care?
The QOF quality and productivity (QP) indicators fall into three categories: prescribing, outpatient referrals and emergency admissions. What will these new indicators mean for primary care and how might they affect the prescribing of cardiovascular drugs and referrals to secondary care ?
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.
Managing chronic obstructive pulmonary disease and cardiovascular disease together
Chronic clinical conditions have traditionally been regarded as individual disease categories within individual patients, although there is often considerable overlap across clinical systems. The monitoring of patients with long-term conditions has historically centred around a traditional model of a nurse-led clinic, utilising an appropriate level of skill mix. The disease categories and associated clinical indicators of the Quality and Outcomes Framework (QOF) have encouraged this approach, but for those managing these patients the presence of various co-morbidities is all too apparent
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.
