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; 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. This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
Back to Basics: Making sense of glycosylated haemoglobin (HbA1c)?
Stratifying stroke risk to guide treatment in patients with non-valvular atrial fibrillation
Antiplatelet (usually aspirin) and anticoagulant (usually warfarin) treatments are available to reduce the risk of stroke in patients with atrial fibrillation (AF) but both have potentially harmful adverse effects and warfarin can be time-consuming and expensive to monitor. Guidance exists for choosing between treatments but is often insufficiently detailed to support an informed choice about the risk and benefits. Prescribers and patients are often left with a choice between aspirin or warfarin, and aspirin – which is perceived to be safer and easy to use – is often chosen. This article explores the evidence for aspirin and warfarin in preventing stroke in patients with AF, and describes how we should change the way that decisions about treatment are made.
Thinking yourself free: understanding the principles of cognitive behavioural therapy
How are you feeling? If you had to measure how you feel on a scale from ‘grotty’ through ‘good’ to ‘great’, how would you rate yourself? More importantly, what do you think it was that decided how you feel today?
Drug treatment for atrial fibrillation
Irrespective of whether the atrial fibrillation is constant or occurs in paroxysms, that is, it is intermittent, the decision to administer antiplatelet drugs or anticoagulants should depend on the patient’s cumulative risk factors. These risk factors include age and previous medical history.
Looking to the future for the management of AF and prevention of stroke
Atrial fibrillation (AF) is becoming an epidemic, affecting 1% to 2% of the population in the developed world. Looking to the future, the prevalence of AF will grow dramatically in the coming decades as the elderly population increases. The growing numbers underline the need to improve the detection of patients with AF and measures for reducing their risk of stroke.
It takes a minute: check your patient’s pulse to see if they are in atrial fibrillation
The prevalence of atrial fibrillation (AF) is increasing with the ageing population. It is well worth detecting and treating as it carries a significant risk of debilitating disease, including stroke and heart failure. This article explains some of the health risks and describes simple actions that can play an important part in both the prevention and management of AF and its consequences.
Why does atrial fibrillation increase the risk of stroke?
Each year there are 150,000 strokes in the UK. Nearly one in five (18%) of the people presenting with a stroke are in atrial fibrillation (AF) at the time of presentation, and one in six strokes are directly attributable to AF. The risk of stroke in AF is reduced by two-thirds with oral anticoagulation, while antiplatelet therapy reduces stroke by one-fifth. The reduction with antiplatelet therapy is broadly consistent with the stroke reduction seen with this therapy in patients with vascular disease or risk factors, and, given that AF largely coexists with vascular disease, the effect of antiplatelet therapy would probably reflect this. The risk of stroke is similar with paroxysmal or permanent AF, in the presence of associated risk factors.
Three simple steps to reduce strokes associated with atrial fibrillation
Stroke is devastating – for the person affected, their family and the NHS. Figures in the recent NICE guideline on stroke show that around 110,000 people have a first or recurrent stroke each year in England, and a further 20,000 have a transient ischaemic attack (TIA).
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.
The ultimate cholesterol-lowering plan – part 2
Part 1 explained how powerful a diet can be in lowering low density lipoprotein-cholesterol (LDL-C) and reducing cardiovascular risk published in BJPCN 2011;8:36-8. Part 2 will focus on the practical step-by-step approach of the Ultimate Cholesterol-Lowering Plan (UCLP) by introducing an alternative consultation technique and detailing the core food elements of the UCLP.1-7 The UCLP includes a number of key strategies each scientifically proven to provide a dose-response effect to cholesterol reduction or cardiovascular risk.
Maintaining tight glucose control during Ramadan
What are the practicalities of supporting people with diabetes who fast during Ramadan? Practice nurses can make a real difference by educating patients before Ramadan starts and advising them on what they need to consider before starting their fast. Patients need to be involved in the whole process so that they are well aware of the importance of managing their diabetes to ensure good control of their glucose levels throughout Ramadan. We review how to assess patients before Ramadan, what adjustments to make to medication and how to follow up.
