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.
Long live the difference? Why women lose out in heart health
In the UK, the last 30 years have seen a significant decline in deaths from coronary heart disease (CHD) in men, but the fall has been less significant in women. This may be because women need a different, more gender-specific approach if they are to benefit fully from recent advances in treatment.
Liraglutide in type 2 diabetes: what NICE recommends?
One in 20 of the UK population—or 2.8 million people—have been diagnosed with type 2 diabetes, according to a recent report based on the Quality and Outcomes Framework (QOF) exception data. Most of these patients will have been identified in primary care, and GPs and practice nurses will be only too well aware of the burden of illness associated with the cardiovascular and microvascular complications of diabetes. The most effective means of reducing the risk of these microvascular complications is to ensure that each patient achieves and maintains their individualised glycaemic target. Recent guidance from the National Institute for Health and Clinical Excellence (NICE) provides recommendations on using liraglutide (Victoza), a new option for patients who do not achieve their target HbA1c using currently available therapies.
Very low energy diets: the key facts
In recent years it seems as if there has been an increase in the popularity of very low energy diets (VLEDs) and new programmes are readily available to our patients on the high street. This article explains the background and theory behind VLEDs so that you can better inform and support your patients if they are considering one of these diets.
How to advise patients on fortifying their diet
Adequate nutrition is an important part of keeping healthy. Some patients – particularly the elderly – may find it difficult to consume an adequate diet to provide all the components to maintain good health. In this case, fortifying the diet may be helpful. Our keep and copy guide over the page provides practical tips for you to photocopy and give to patients and their carers on how to fortify their diet without using oral nutritional supplements.
Whole grain breakfasts for trimmer waists
Central obesity remains a big issue in the UK. The accumulation of adipose tissue in the abdominal region is a particular risk factor for chronic disease and mortality.1 In 2008, 39% of adults in England had a waist circumference indicative of central obesity (above 88 cm for women and 102 cm for men).2,3 Two proven effective dietary strategies for reducing waist circumference are the inclusion of whole grain foods in the diet and the avoidance of meal skipping.4 Advice to start the day with whole grain breakfast cereal and/or whole grain bread combines these two strategies in one simple and feasible practical message.
Back to Basics: Recognising the four types of coronary artery disease
Hearts and hormones: what’s the impact of hormonal contraception and HRT on cardiovascular risk?
The impact of female hormones on cardiovascular risk is a hot issue. Many nurses working in the NHS, including in general practice, are aged 50 or older. This means that there is a strong possibility that some of us may be experiencing menopausal symptoms, along with our patients. In this article, we look at the use of hormonal therapies at the time of the menopause, with particular reference to cardiovascular risk. We will also touch on the use of oral contraception and associated cardiovascular factors.
Helping patients with swallowing problems after a stroke
Swallowing really is a life or death matter. Nearly half of people who have had a stroke will initially experience difficulty swallowing. This is called dysphagia. In this article, we look at the anatomy and physiology of swallowing, what can go wrong in people who have had a stroke, and what can help. Explanations are given clearly, using simple language that you can use with patients and their family members.
