The Mid and South West Wales Cardiac Network (now the South Wales Cardiac Network) identified the need to devise resources to encourage patients to dial 999, safely signposting those calling into a GP practice complaining of acute chest pain to the 999 system. The resources and educational sessions were well received, with outcomes demonstrating improvements in staff confidence, backed up with the rationale and guidance, and an improvement in those directly accessing the 999 system, with the potential to receive reperfusion more quickly, preserving myocardium.
The GRANITE project: evaluating a novel cardiovascular prevention model in Scotland
Targeted case-finding for cardiovascular disease (CVD) prevention may be preferable to universal screening. Quality Improvement Scotland (QIS) has recommended that identification of high-risk individuals is needed. In this study, probable CVD risk in patients within the 40-70 years age range who were not on the CHD, Diabetes and Stroke registers and who were not already receiving statins was analysed using a predictive software toolkit which utilised the ASSIGN risk calculator. This programme effectively identified a patient population with a probable high 10-year CVD risk requiring intervention for CVD prevention after clinical assessment.
The varicose vein consultation: an aide-mémoire
Varicose veins affect about 25% of adults in the UK,1 with roughly equal prevalence in men and women, although women are more likely to present. Approximately 50% of varicosities involve the great saphenous vein (GSV), 30% the short saphenous vein (SSV), and 20% both.2 Patients may present to primary care with aesthetic concerns, or with symptoms including night cramps, itching, mild swelling of the ankles or a dull ache in the legs (usually exacerbated by standing for long periods and worse at night). The motivation for presentation should be sought as this will guide your management strategy.3 Varicosity size may not correlate with the severity of symptoms as reported by the patient.
Attitudes to taking medications for cardiovascular disease prevention
Cardiovascular disease prevention is one of the main challenges facing primary care today. In order to reduce the burden of disease, national guidelines recommend that asymptomatic patients who are at high risk of cardiovascular disease should be offered preventive medications. This article discusses cardiovascular disease risk assessment, communication of this risk to patients and attitudes of both general practitioners and patients to preventive medications.
Statin prescribing in Europe: a comparison of differences and potential impact on health outcomes
The benefit of treatment with HMG-CoA reductase inhibitors (statins) is unquestioned, with multiple studies over the last 20 years having shown that statins improve cardiovascular (CV) outcomes.1 Although all statins reduce low-density lipoprotein cholesterol (LDL-C), their potencies differ. The decreasing order of potency (per milligram) for LDL-C reduction is: rosuvastatin, atorvastatin, simvastatin and pravastatin.
Integration of cardiac services
Prominent consequences of the Health and Social Care Act which has now passed into law will be the increased commissioning of cardiac services and changes in how they are delivered. This Act, although establishing an NHS Commissioning Board to provide commissioning guidance, intends to increase markedly GPs’ power to commission services. Monitor, the non-departmental public body, will be developed into an economic regulator to oversee access and competition within the NHS
Time to start insulin in general practice
General practices are under increasing pressure to initiate insulin in type 2 diabetes, as it would be more efficient for the health service and more convenient for most patients. There are many different approaches to starting insulin, but it is essential for practice nurses to work closely with patients and progress slowly to ensure successful and safe outcomes.
Fat: separating the facts from the fiction
Fat is an important part of the diet, providing fat-soluble vitamins and essential fatty acids, as well as a valuable source of energy or calories. Fat also increases the palatability and carries the flavour of many of our foods. The problem is, despite decades of public health campaigns, most of us still eat too much of the wrong fat. Understanding the different types of fat can help us to advise our patients on ways to optimise their diets.
Editorial 1 – Putting chronic liver disease on the primary care agenda
Chronic liver disease is a problem for all of us. It develops silently, often taking many years to cause sufficient damage to be detectable or cause signs or symptoms for which a patient would seek attention. Primary care has a central role in improving the prevention and early detection of chronic liver disease. This special issue of the British Journal of Primary Care Nursing (BJPCN) and Primary Care Cardiovascular Journal on chronic liver disease is full of step-by-step guides and informative articles to give you the key information and tools to get to grips with this important condition.
On the beat: Controlling heart rate in angina and heart failure
Controlling heart rate is a key element of good care of patients with angina or heart failure. In this article we explore the benefit of effective heart rate control to reduce hospitalisation and alleviate symptoms. Measuring heart rate is simple, and can provide valuable benefits for many patients.
Editorial 2 – If I had one wish for improving the management of liver disease…
Chronic kidney disease: the no tears review
Many drugs are cleared from the body by the kidneys, so careful medicines management is especially important in people with chronic kidney disease (CKD). This article explains how to ensure CKD patients receive recommended therapies designed to protect their kidneys and reduce their risk of a heart attack or stroke.
