Recent research suggests that post-MI patients are not being optimally managed. Awareness and implementation of guideline recommendations could improve outcomes in this patient group.
National GPwSI in cardiology survey 2010
The first general practitioners with a special interest (GPwSI) in cardiology services were set up more than 10 years ago but there is little information available on the national level about service provision. The authors invited all GPwSIs in cardiology to complete a survey detailing their qualifications and experience, range of services provided, capacity and clinical governance. The results are presented here.
A primary care service for cardiovascular risk reduction in first-degree relatives of patients with premature coronary heart disease
Cardiovascular disease continues to be the leading cause of premature morbidity and mortality in the UK.1 Primary prevention not only is cost-effective but is endorsed as a priority by healthcare systems in the UK, and indeed globally. We describe here a targeted prevention service, which showed that the modifiable risk factors of obesity and overweight, smoking and low levels of high-density lipoprotein cholesterol were highly prevalent in first-degree relatives of patients with premature coronary heart disease.
It is astonishing with how little reading a doctor can practise medicine
“It is astonishing with how little reading a doctor can practise medicine, but it is not astonishing how badly he may do it.-(William Osler, Aequanimitas, Books and Men)
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.
Atrial fibrillation and stroke: Optimising prevention and treatment
Uniquely, AF is an eminently preventable cause of stroke with a simple and highly effective treatment. AF is common and affects over 600,000 patients in England (1.2%). It is a major predisposing factor for stroke, and strokes caused by AF can be particularly severe and disabling. The annual risk of stroke is five to six times greater in AF patients, but […]
Effective management of atrial fibrillation
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia, and has a significant impact on morbidity and mortality. Treatment is tailored to the individual. This article will review the rhythm-management strategies for patients with atrial fibrillation, and discuss the roles of secondary and tertiary care.
Management and early treatment of transient ischaemic attack (TIA)
The White Paper, Saving lives: our healthier nation (1999), set out a target to reduce the death rate from coronary heart disease and related illnesses such as stroke by 40% in the under-75s by 2010;1 recent trends indicate that this target will be met. Although the past forty years have seen a significant reduction in age-standardised stroke mortality rates, stroke still accounts for around 53,000 deaths each year in the UK, with more than 9,500 of these occurring in the under-75s.2 This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
What is the real role of anticoagulants in atrial fibrillation and stroke?
The majority (84%) of people with AF are over the age of 65 years. In the UK, the prevalence of AF is 7.2% for patients aged 65 and over. AF is a particularly important risk factor for stroke in the elderly. 15% of all strokes are associated with the arrhythmia, increasing to 36% in people over the age of 80. The prevalence of AF is higher in men at all ages, although the overall number of patients with AF is approximately equal between the sexes because of unequal death rates. In overall terms, approximately 50% of patients with AF are 75 or over, and over half of these are women.
Catheter and surgical ablation of cardiac arrhythmias
Catheter and surgical ablation of cardiac arrhythmias have evolved rapidly over the last 30 years. Catheter ablation of ‘simple’ atrial arrhythmias such as supraventricular tachycardias and typical atrial flutter is very successful and low-risk. Catheter ablation of atrial fibrillation (AF) is now also successful in restoring sinus rhythm for the majority of patients. The place of invasive treatment for ventricular arrhythmias in various contexts is also evolving.
Following implementation of the Department of Health’s Chapter 8 of the National Service Framework in 2005, there has been expansion of arrhythmia services in the UK. In 2010, the capacity of hospitals to treat these arrhythmias is growing rapidly, and perhaps the main barrier to patient access is the limited awareness among would-be referring physicians of which patients should be referred for such treatments. This review article outlines the ways in which arrhythmias can be treated by catheter and surgical ablation, and provides success and complication rates to help the reader determine when, and for whom, these treatments might be appropriate.
