The Keynote address at the Issues & Answers conference was shared by Dr Nicholas Boon and Professor Huon Gray and focused on delivering best practice in the real world.
Here, Dr Boon presents the case for a new era in personalised medicine for primary care cardiology and explained the important concept of ‘lumpers and splitters’.
Here, Professor Gray describes the national priorities, organisations and systems that are helping to improve practice in cardiovascular disease.
Real life issues & answers:
The Female Hormonal Patient
Dr Louise Newson highlighted the need for improved care for women experiencing the menopause. Even if women do not experience menopausal symptoms, there are associated health risks including bone loss, osteoporosis, central obesity, raised cholesterol, cardiovascular disease, dementia and depression. She provided a simple approach to prescribing HRT.
The Mental Health Patient
A new tool may help GPs in clinical decision-making with patients with CVD and mental health issues. SHERPA (Sharing Evidence Routine for Person-centred Action) has a simple, three-step consultation framework to help clinicians provide holistic bio-psycho-social care. Patients with mental health issues and cardiovascular disease provide long-term challenges to healthcare professionals that demands a careful, individualised approach.
The Cardiovascular Rehabilitation Patient
Dr Scott Murray gave a wide ranging and challenging presentation on the future of cardiovascular disease prevention. He was formerly an interventional cardiologist and gave a powerful argument for the need for health services to stop being reactive in cardiovascular disease and put more resources into prevention. His comment was that, “We are putting metal stents into an inflammatory disorder – we have to think wider”.
The Overweight Patient
Managing the patient with obesity is a frequent challenge for most health professionals. There is no single intervention which is applicable and multiple sources of information on diet and activity are widely available, but vary significantly in their evidence base and quality. This presentation will focus on medical and surgical strategies for weight management, to whom and how we should apply them and both the challenges and benefits of doing so.
The Diabetic Patient
Among diabetes-related complications, cardiovascular disease (CVD) is the leading cause of mortality and adverse outcomes in people with Type 2 diabetes. Over two-thirds die from CVD and even more suffer serious CV-associated complications. There is a two to four-fold increased risk of coronary artery disease and a decreased life expectancy of 6-7 years for those with the condition compared to those without.
The Lipid Disorder Patient (incl. FH)
The current evidence base for lipid lowering, including use of Ezetimibe, indications for use of PCSK9 inhibitors, treatment targets, options for patients with statin intolerance, the implications of the ‘legacy effect’ of statin treatment, and lipid lowering therapy in the elderly.
The Balloon Debate: is technology the only way forward for primary care?
Professor Mike Kirby triumphed in a fascinating ‘balloon debate’ at I&A 2018 looking at the impact of technology in primary care. Six speakers presented their arguments for and against the motion before being ejected from the balloon by audience voting until only one was left!
Updated NICE Heart Failure guidelines
In a session organized by the Primary Care Cardiovascular Society, Dr Jim Moore, Professor Jerry Murphy, Helen Williams and Hannah Waterhouse discussed whether the updated NICE heart failure (HF) guidelines are “furthering evidence or a missed opportunity”.