Keep up the good work’ is the theme of this issue of BJPCN, with latest figures showing that the structured care we provide to our patients is helping to save lives. But we are not there yet – so we are looking at remaining challenges in managing cardiovascular disease and what more we can do to really make a difference to our patients’ lives.
Editorial
Editorial
The effective management of long-term conditions such as chronic kidney disease (CKD) is probably the single greatest challenge faced by the NHS. The population is growing and people are living longer. Every week, the life expectancy for a newborn baby in the UK increases by more than 24 hours. While this is, in part, testament to the success of our health services, it also places steadily increasing demands upon them. As the population ages, the number of people living with long-term conditions is predicted to triple by 2050.
Editorial – Going back to basics in cardiovascular disease
There are 28 cardiac and stroke networks in the country. They play an important part in implementation of national strategies, enabling high-quality services to be planned and delivered to patients within the framework of primary and community care. One of the most useful contributions of the networks is provision of education and training for primary care staff. The “Back to Basics” material in this supplement forms the backbone of what is presented at study days. The articles cover some of the most common cardiovascular conditions that are seen in primary care, showing clearly what causes the symptoms, how best to assess and manage patients, and how the treatments actually work. They help healthcare workers both to understand these conditions and to explain them to patients, and therefore really improve patient care.
Editorial
This educational supplement is brought to you by the Cardiac and Stroke Network. What is this Network, and how can it further support your education and development?
Editorial
Chronic kidney disease (CKD) has shot up the primary care agenda over the last few years, and is now well recognised as an independent risk factor for cardiovascular disease (CVD). At the same time, CVD is a risk factor for progression of CKD. The close links between CKD and CVD mean we have to get to grips with assessing patients’ kidney function and ensuring those with CKD receive the treatment needed to prevent progression. This special issue devoted to CKD is full of step-by-step guides and illustrated articles to help you get to grips with this important condition.
Editorial
The government’s new public health strategy, Healthy Lives, Healthy People, aims to transform public health and – perhaps for the first time – to create a ‘wellness’ service to meet today’s health challenges. We may have our reservations about the NHS reforms, but improving public health is something we can all sign up to. So this issue of BJPCN focuses on one of today’s key public health challenges – obesity.
Editorial
Are you sitting comfortably? Then I’ll begin. Once upon a time… Telling stories is something that many of us do with our children. But what about with our patients, and what about encouraging patients to tell their stories? In this issue of BJPCN, we share some exciting new research showing that patients with high blood pressure can learn from each others’ stories. And we help you to fill in the gaps so you’ve got a clear story to tell during routine consultations with patients with cardiovascular disease and diabetes.
Improving the management of cardiovascular disease during pregnancy
It is exceedingly uncommon for a woman in the UK to die during pregnancy, with maternal mortality in the region of one death per 10,000 maternities1. Although there have been very significant improvements in antenatal care, such as a marked reduction in the number of deaths due to thromboembolic disease, other areas are trailing behind. One such area is cardiac disease – now the leading cause of maternal death in the UK. These relatively rare deaths also mask the much larger issues of maternal, fetal and perinatal morbidity. The most recent Confidential Enquiries into Maternal Death and the new European Society of Cardiology guidelines summarised in this issue of the PCCJ highlight the major clinical issues and attempt to provide consensus opinion regarding optimal care in what is a relatively evidence-sparse field.
Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management
The prevalence of many physical illnesses is increased in people with severe mental illness and accounts for around three quarters of all deaths; cardiovascular disease is the commonest cause of death. The level of screening for and management of diabetes and cardiovascular risk factors remains low but a straightforward yet systematic care pathway should go a long way towards reducing the health inequalities experienced by people with severe mental illness.
The EPCCS and the implementation of CVD prevention in general practice
The European Primary Care Cardiovascular Society (EPCCS) exists to inform, support and interact with general practitioners (GPs) across Europe in relation to cardiovascular disease, including stroke and diabetes. The EPCCS provides an interactive and expanding website at www.epccs.eu with news, comments, information, meeting reports and slide presentations.
Out of the shadows: attitudes and beliefs of primary care practitioners about depression after myocardial infarction
After myocardial infarction (MI) half of all patients will experience an episode of depression. We carried out the first survey of GP and primary care nurse attitudes and beliefs about depression in post-MI patients. Our sample was drawn from readers of two major cardiovascular journals: a total of 813 GPs and nurses responded. Primary care practitioners underestimated the prevalence of depression which is two and a half times more common in post-MI patients than estimated. Diagnosing depression was viewed as complex by both groups but much more so by nurses. Compared to nurses GPs had a much better understanding of the signs and symptoms of depression and were more confident in using depression screening tools. General acknowledgement of the negative impact that depression can have on outcomes was reported by the majority of participants. The practice of depression-trained professionals was more positive compared with those who had no recent education. If primary care practitioners address the epidemic of depression in post-MI patients, outcomes will be dramatically improved and lives could be saved.
Cardiovascular drugs and sexual dysfunction
Men and women with cardiovascular disease are currently treated with multiple medicationsto reduce their cardiovascular risk. Although the links between erectile dysfunction (ED) andcoronary heart disease (CHD) are well established and ED often precedes the onset of CHD by3-5 years, few men in UK general practice are asked about their erections prior tocommencement of therapy for cardiovascular disease. The presumption is often that if thepatient has a sexual problem, then he will mention it and at that point the therapy can bechanged. There are two drawbacks with this approach: first, men do not readily volunteersexual problems, and second, unless the therapy change is made quickly, the problem isunlikely to resolve.5 Physicians must be aware that in many cases, such as the use of betablockersafter acute myocardial infarction, the appropriate management of the cardiaccondition is the major priority.