We have three new licensed anticoagulant agents–dabigatran, rivaroxaban and apixaban. Their use for stroke prevention in AF is discussed: primary care is central to their utilisation.
The new oral anticoagulants, and their use in stroke prevention
Recognising stroke and transient ischaemic attack – the role of primary care
Stroke is the third commonest cause of adult death and the leading cause of complex disability in the UK. This article will discuss the importance of the early recognition of stroke and transient ischaemic attack and the role of primary care staff in implementing national guidelines. Practical case study examples are included.
How can we avoid a stroke crisis?
A report from a multidisciplinary alliance has made a compelling case for a coordinated planin Europe to reduce the health, social and economic burdens of stroke related to atrialfibrillation (AF). The group comprises eminent cardiologists, neurologists, a healtheconomists, hospital pharmacists, a haematologist and representatives from patientorganisations.How Can We Avoid a Stroke Crisis? has been endorsed by 17 medical and patientorganisations, including the European Primary Care Cardiovascular Society. Its aim is tohighlight to European policy makers the need to achieve earlier diagnosis and bettermanagement of AF across Europe, with the ultimate goal of reducing the risk of stroke inpatients with AF. The key points summarised in the report are shown in table 1.
Current evidence for the management and early treatment of transient ischaemic attack
Transient ischaemic attack (TIA) is an important risk factor for stroke. Early recognition of symptoms and timely secondary prevention significantly reduce stroke risk. We review current evidence and guidelines for early management and treatment of TIA, including early antiplatelet therapy, specialist review, and recognition and treatment of other risk factors. The roles of carotid artery and brain imaging are also considered.
Recognition of post-stroke depression: a chance to improve outcomes
Depression is common after a stroke. All stroke patients should have their mood assessed. A range of evidence-based interventions may be used, and guidelines should be implemented since failure to treat depression leads to poorer outcomes in rehabilitation and recovery.
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.
How to use the GRASP-AF tool to reduce stroke risk in patients
Eating healthily on a tight budget
Save the Children, a charity well known for its work helping children in war-torn or faminestruck countries, recently announced that it is now handing out grants to struggling UK families who cannot afford to feed themselves. In a recent report, the charity suggests that the credit crunch has led to an increase of 11.3% in cost of food over the last year. It is not surprising that many parents have now cut back on food expenditure, with the poorest of families spending less on their weekly shop than ever before. How can we provide patients with tips on eating healthily on a tight budget?
Treating erectile dysfunction safely and effectively
Erectile dysfunction (ED) and vascular disease share the same risk factors and commonly co-exist. The presence of ED in otherwise asymptomatic men is, therefore, often a useful early warning sign of silent vascular disease. This fundamental concept highlights the importance of ‘looking beyond the penis’ in the evaluation of the ED patient, and challenges practice nurses to consider ED and sexual activity as part of their routine evaluation of patients. Once diagnosed, there is a range of effective treatments for ED, and guidance on how to use them safely in patients with cardiovascular disease (CVD).
