Unstable angina describes a syndrome that is intermediate between stable angina and myocardial infarction: an accelerating or ‘crescendo’ pattern of chest pain that lasts longer than stable angina, occurs with less exertion or at rest, or is less responsive to medication. Unstable angina – like myocardial infarction – is an acute coronary syndrome (ACS), in contrast to stable angina, which is a chronic condition. It affects approximately six out of every 10,000 people. In this article, we review what causes unstable angina and how it should be diagnosed and treated.
Unstable angina
24-hour ambulatory blood pressure monitoring
Ambulatory blood pressure monitoring (ABPM) is used widely in secondary care hypertension clinics, so what about its use in the primary care setting, where the majority of hypertension clinics take place? What are the potential benefits of ambulatory monitoring? Which patients should ABPM be used for? In this article we review the nuts and bolts of ABPM – when to use it, how to perform the test to obtain an accurate assessment of 24-hour BP and how to apply the results in clinical practice.
Chewing the fat
Some fat is essential for maintaining good health, in order to provide essential fatty acids and the fat-soluble vitamins A, D, E and K. Essential fatty acids can only be derived from foods because they cannot be synthesised by the body. However, the hard truth is that essential fatty acids represent only a very small amount of total energy needs and most people still consume too much fat. How much fat should we be eating? What is the difference between different types of fats and what advice should we be giving patients about fats to reduce their risk of cardiovascular disease?
Diagnosing diabetes
The number of people with diabetes in the UK is almost 1.8 million and this is continuing to rise, according to recent figures. But only about half of these are currently diagnosed. It is obviously essential to ensure that these people are diagnosed as early as possible and then managed appropriately to ensure they receive the best possible care to minimise long-term complications. In this article, we review how to diagnose diabetes accurately, based on good practice recommended in standard two of the National Service Framework (NSF) for Diabetes. What should we be measuring in people who present with the classic symptoms and in those who do not to ensure an accurate diagnosis of diabetes?
Healthy eating for type 2 diabetes: let’s go shopping
People with diabetes used to be advised to watch their carbohydrate – particularly sugar – intake. But dietary recommendations have developed over the past few years so that they are now similar to the healthy diet that we should all be eating. Are there any remaining differences in what we should be telling patients with diabetes about their diet? Fewer than you might think. In this article we take a ‘supermarket tour’ that explains what patients with diabetes should be putting in their trolleys and what they should be leaving on the shelves.
Changing practice in hypertension: ASCOT win for newer antihypertensives
The British Hypertension Society Guidelines published last year were widely welcomed as a major step forward in the management of patients with high blood pressure. In common with all recent guidelines they were based on a review of all relevant evidence, mainly gained from clinical trials. However, medicine is never static and research is ongoing. A major study – ASCOT – has provided new information about the benefits of newer combinations of antihypertensives compared to older drugs. What did the study show and how should we act on the results to improve outcomes for our patients?
Isolated systolic hypertension
Isolated systolic hypertension (ISH) – an increase in the higher of the two numbers when blood pressure (BP) is measured – is the commonest type of high BP in older people over the age of 60. The systolic pressure used to be dismissed as less important than the lower number – diastolic BP – but studies have shown that it is associated with increased risk of cardiovascular disease. ISH accounts for up to 75% of the overall incidence of uncontrolled hypertension in the elderly and appears to be more common in women than men.
How to score top marks for secondary prevention of coronary heart disease
In this second article in our series on the Quality and Outcome Framework (QOF), we will discuss how to maximise points in the secondary prevention of coronary heart disease (CHD) and heart failure. This will include lipid management and smoking cessation.
One year on: boldly going where no primary care nurse has gone before
Welcome to the first year anniversary issue of the British Journal of Primary Care Nursing (BJPCN). It has been an eventful year for primary care nurses, with new challenges coming from all directions. In each issue of the journal we have tried to provide practical information and tools to help you find your way through the expanding universe of primary care in cardiovascular disease and diabetes – to boldly go where no primary care nurse has gone before!
Aspirin in patients with diabetes
Patients with diabetes are at high risk of cardiovascular disease and aspirin is an important part of prevention strategies. Although it is effective and relatively well-tolerated, studies have shown that many patients with diabetes are not taking aspirin. In this article, we review why aspirin should be considered in patients with diabetes, the benefits it might achieve and areas where caution is required.
Making sense of the Quality and Outcome Framework of the new GP Contract
The Quality and Outcome Framework (QOF) of the new GP Contract will be the biggest experiment in improving the quality of care for patients anywhere in the world. By April 2005, we will see how well Primary Care can deliver. In this series, we provide a step-by-step guide on how your practice can get QOF points, including practical information on what data to collect and how to record it. Over the coming months, we will be discussing the best ways to maximise the quality of care and will concentrate on the cardiovascular and diabetes elements of the QOF. We will discuss the setting up of registers, practical tips, examples from practices that are delivering well, how to check how well you are doing from your own IT system and from Quality Management Analysis System and, of course, how to deal with exception reporting and the PCT QOF visit.
