“I like to think of medicine in our day as an ever-broadening and deepening river, fed by the limpid streams of pure science-
Christian A. Herter (1865-1910), US neurologist, New York.
EDITORIAL | Moving with the times
Delivering CVD care: GPs under pressure and disempowered – a qualitative study
GPs, practice nurses and other primary healthcare professionals are now at the frontline of managing cardiovascular disease (CVD) and delivering preventive care. The aim of this study was to explore clinicians’ experiences and their views on the factors that influence their ability to fulfilthis demanding role. GPs and other primary healthcare professionals expressed similar views. In particular, they reported a sense of pressure and disempowerment, and voiced concerns about the ability of general practice to take on its greater role in reducing the burden of CVD.
It’s not just a high cholesterol level, it can be an indicator of genetic disorder
7.5 mmol/L) should prompt clinicians to think of familial hypercholesterolaemia. A family history of premature heart disease should further raise suspicion. This dominantly inherited genetic abnormality deserves as much attention as the oncogenes such as BRAC 1 and 2. HEART UK – The Cholesterol Charity – has provided editorial support and review of this sponsored FH series.This article was made possible by an unrestricted educational grant by Sanofi, who had no control over content.
Chronic kidney disease, cardiovascular risk and primary care
This article describes the interrelationship between chronic kidney disease (CKD) and cardiovascular disease and defines the basis for the various interventions which have been recommended in national guidelines. It also provides a critique of currently available guidelines and suggests where changes may be desirable in future.
Identifying people with or at risk of type 2 diabetes
In this paper, we summarise previously reported findings from the MY-WAIST study, which aimed to evaluate a primary care strategy for identifying people with undiagnosed type 2 diabetes or at increased risk of developing this condition. Recruitment was unexpectedly low, but the qualitative data collected, including interviews with healthcare providers, helped to highlight some of the reasons for poor uptake of the appointments offered. Perceived barriers to recruitment included heavy workloads and competing demands in primary care. Lower uptake in people from harder-to-reach groups was identified in our quantitative findings and was also suggested by healthcare providers’ perceptions about the characteristics of patients who attended.
Coherent management of diabetes, weight & cardiometabolic risk
Successful management of individuals with diabetes, or any other single component of the metabolic syndrome, requires treatment of all the related physiological systems as a whole. This treatment must be underpinned by the management of obesity, and drugs should be preferred that address the entire portfolio of the metabolic syndrome.
The importance of early diagnosis: how to identify patients with FH for diagnosis and referral
Familial hypercholesterolaemia (FH) is under-diagnosed and under-treated, despite clear evidence-based guidelines for identification and management, and the availability of low-cost, generic, high-intensity statin treatment. Genetic cascade testing is the key to early diagnosis, which can help ensure that this treatment is no longer ‘too little, too late’.
HEART UK – The Cholesterol Charity – has provided editorial support and review of this sponsored FH series.This article was made possible by an unrestricted educational grant by Sanofi, who had no control over content.
The ESH/ESC guidelines for the management of arterial hypertension
There still remains a significant gap between the goal of optimal treatment of hypertension and ‘real life’ practice. As a consequence, hypertension remains a leading cause of cardiovascular related morbidity and mortality. There is a continuing need to improve both the detection and management of hypertension, with a view to improving the efficacy of treatment including lifestyle interventions and outcomes. In order to address these issues. The European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) have recently published guidance on the management of arterial hypertension.
Cardiovascular disease risk prediction in the UK: which is the best risk prediction model?
Identifying those people at an increased risk of cardiovascular disease (CVD) who might benefit from a therapeutic intervention or lifestyle advice is an important challenge. We summarise here the performance of QRISK2 against the NICE version of the Framingham Risk Score.
NHS Health Checks: time to raise awareness about dementia
The NHS Health Check is changing again. Since the beginning of April 2013, practice nurses have been expected to raise the issue of dementia when seeing patients aged 65-74. But why (I can hear you ask)? Surely we have enough to do! This article explains why dementia matters, and sets out your role in the NHS Health Check.
ENHANCE HF™: optimising the management of heart failure in primary care
Heart failure (HF) imposes a significant burden across the UK, both for patients and the NHS. Optimal management of HF could improve patient outcomes and reduce costs for clinical commissioning groups (CCGs). HF is, however, complex to manage, and despite recent improvements there is evidence of a continuing lack of adherence to guideline recommendations. Enhance HF™ is a tool that supports GPs in optimising the management of HF due to left-ventricular systolic dysfunction to help deliver more costeffective care for patients in their practice.
