We describe a patient with heart failure, diagnosed from clinical history and examination, and with a raised BNP. Despite treatment, her symptoms progressed. Echocardiography, performed after a six-month delay, showed a large mass. After excision of the mass, an atrial myxoma, the patient recovered rapidly and well.
ECG recording in primary care: is it done correctly?
The ECG is the most commonly performed cardiac investigation but incorrectly recorded ECGs may lead to misdiagnosis. In this study, questionnaires were used to assess the pre-training perceived and actual knowledge of correct ECG recording technique among 54 primary care staff. Training was then performed and, after training, many staff admitted that their previous practice had been incorrect some or all of the time and said that they would change their practice.
Discussing weight status with patients: words and context matter
Although primary care consultations appear to represent an excellent opportunity to discuss a patient’s weight status, GPs may be reluctant to do so. Excess weight can be an extremely sensitive issue and some terms (such as obese and fat) may provoke highly negative emotions. People who are overweight or obese say they would find unsolicited advice off-putting, but would also be more likely to try to lose weight if advised by a health professional than by family or friends.
The numbers expected to be treated (NETT): a way forward in CVD prescribing?
55 years; targeting those at high Framingham CVD risk; and tailoring dose according to risk stratification. By combining price and potency data with our CVD patient risks database, we modelled potential benefit (myocardial infarctions [MIs] prevented), cost and numbers expected to be treated for each strategy.
Clinical management of primary hypertension in adults
Important modifications to the NICE clinical guideline on management of hypertension include changes in definitions of the stages of hypertension, greater use of ambulatory and home blood pressure monitoring, changes in treatment recommendations for those aged over 80 and changes in antihypertensive drug treatment recommendations.
Issues and challenges in hypertension management today
Issues and challenges in hypertension management today
Dr Chris Arden GP, Chandlers Ford; GPSI Cardiology, Southampton
Most hypertensive patients fail to achieve their target blood pressure despite treatment. As a result, they have a significantly increased risk of stroke and heart attack. Primary care professionals can correct this situation, reducing morbidity and mortality through accurate blood pressure measurement and effective treatment, often with more than one drug. The availability of a new angiotensin receptor blocker, Azilsartan medoxomil, provides an important addition to the choice of available treatment.
This video offers primary care professionals a focussed review of high blood pressure, its measurement and modern treatment.
This sponsored video has been organised and funded by Takeda UK
Prescribing Information for Edarbi®-(azilsartan medoxomil) can be seen hereCode: AZL121001d. Date of prep: December 2012
Genetic hyperlipidaemias: finding, diagnosing and managing them
Cardiovascular disease (CVD) risk assessment is a central part of the strategy for identification and treatment of high-risk cases, as was recognised in the National Institute for Health and Clinical Excellence (NICE) guidelines on lipid modification. A national strategy devised by the Department of Health for screening all individuals aged between 40 and 75 years exists in the UK though implementation and uptake have been variable. Unfortunately, in screening programmes the greatest uptake tends to be among the white population, wealthier people and women rather than among those groups in which CVD is over-represented: men, poor individuals and those from ethnic minorities. This has posed a great challenge to risk screening but non-traditional approaches including those in places of worship, pharmacies and communally-led initiatives seem to lead to greater success.
A weighty matter: managing obesity in primary care
At least 22% of men and women in the UK are obese. All health professionals need to be skilled in the initial management of obesity. Behaviour change is core to any strategy, as are brief interventions that incorporate advice on physical activity and healthy eating. Training in primary care needs greater emphasis for the future management of obesity.
Screening for asymptomatic atrial fibrillation at seasonal influenza vaccination
The study found a significant prevalence of sub-clinical atrial fibrillation (AF) within the community. AF confers a five-fold risk of stroke, and the risk of death is doubled in AF-related stroke.
Prescribing DPP-4 inhibitors – Are there clinically relevant differences?
There are now four agents in the new class of glucose-lowering agents called dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) available in the UK. They are, in order of launch in the UK, sitagliptin, vildagliptin, saxagliptin and linagliptin. Several others are in the pipeline and are likely to be launched before long. This article will discuss their place in treating diabetes and the differences between them.
Validating heart failure registers in primary care: a way to better outcomes and higher QOF payments
We hypothesised that practice heart failure registers may not be complete or robust due to patients not always being allocated the correct READ codes. We set up a project which improved practice heart failure registers. Ensuring practices have robust registers, by improving clinical coding in general practice, means more accurate prevalence levels can inform planning and commissioning of heart failure services.
Profiles of primary cardiovascular risk in STEMI: how do these differ between men and women?
Our study investigated the primary risk factors present in patients admitted for acute coronary syndromes. There were significant numbers of current smokers, and patients with hypertension, hyperlipidaemia and diabetes. Aggressive secondary prevention measures are recommended, and education on hospital discharge is essential.
