Chronic clinical conditions have traditionally been regarded as individual disease categories within individual patients, although there is often considerable overlap across clinical systems. However, for those managing these patients the presence of various co-morbidities is all-too apparent. It may be time to consider a new approach to management of these patients.
Cardiovascular morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) is nearly double the rate in the general population without COPD. And for those with cardiovascular disease (CVD) and COPD, heart failure is the most common cause of hospitalisation.
Breathing new life into managing patients with chronic obstructive pulmonary disease and cardiovascular disease
What do the new QOF indicators mean for primary care?
The QOF quality and productivity (QP) indicators fall into three categories: prescribing, outpatient referrals and emergency admissions. What will these new indicators mean for primary care and how might they affect the prescribing of cardiovascular drugs and referrals to secondary care ?
Cardiovascular drugs and sexual dysfunction
Men and women with cardiovascular disease are currently treated with multiple medicationsto reduce their cardiovascular risk. Although the links between erectile dysfunction (ED) andcoronary heart disease (CHD) are well established and ED often precedes the onset of CHD by3-5 years, few men in UK general practice are asked about their erections prior tocommencement of therapy for cardiovascular disease. The presumption is often that if thepatient has a sexual problem, then he will mention it and at that point the therapy can bechanged. There are two drawbacks with this approach: first, men do not readily volunteersexual problems, and second, unless the therapy change is made quickly, the problem isunlikely to resolve.5 Physicians must be aware that in many cases, such as the use of betablockersafter acute myocardial infarction, the appropriate management of the cardiaccondition is the major priority.
New glucose-lowering therapies for diabetes: a review
The sulphonylurea group of drugs and the biguanide drug metformin have both been available for use as glucose-lowering therapies for more than 50 years. There were, however, few other clinically relevant developments in this area of pharmacotherapy until about the year 2000. At that time a new class of glucose-lowering therapies, the thiazolidinediones pioglitazone and rosiglitazone, was launched. In 2007 two more new classes of therapy were launched, the dipeptidyl peptidase-4 (DPP-4) inhibitors and the glucagon-like peptide-1 (GLP-1) mimetics; both of these classes of agents work on the incretin pathway.A further new class of glucose-lowering agents, the sodium glucose co-transporter 2 (SGLT2) inhibitors, is likely to be launched in the next year or two. So much activity in glucose lowering pharmacotherapy in this past 12 years perhaps makes up for the previous 40 years of relative inactivity!In this article we discuss new glucose-lowering therapies and consider their place in diabetes management from the primary care perspective.
The ‘no tears’ approach to medication reviews
Ten per cent of the annual NHS budget is spent on medication, with about 75% of this is prescribed in primary care. Ensuring that this money really improves patients’ health is vitally important. As the population ages, more people require increasing numbers of medications for chronic conditions and a third of elderly patients are taking four drugs or more for a spectrum of conditions. But this creates a major challenge – as research reveals that fewer than half of these patients take their medicines as prescribed. How can this challenge be addressed? This new series will provide simple practical guidance on how to conduct an effective medication review for a spectrum of long-term cardiovascular conditions.
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.
Atrial fibrillation and stroke: Optimising prevention and treatment
Uniquely, AF is an eminently preventable cause of stroke with a simple and highly effective treatment. AF is common and affects over 600,000 patients in England (1.2%). It is a major predisposing factor for stroke, and strokes caused by AF can be particularly severe and disabling. The annual risk of stroke is five to six times greater in AF patients, but […]
Effective management of atrial fibrillation
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia, and has a significant impact on morbidity and mortality. Treatment is tailored to the individual. This article will review the rhythm-management strategies for patients with atrial fibrillation, and discuss the roles of secondary and tertiary care.
Management and early treatment of transient ischaemic attack (TIA)
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;1 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.2 This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
