The majority (84%) of people with AF are over the age of 65 years. In the UK, the prevalence of AF is 7.2% for patients aged 65 and over. AF is a particularly important risk factor for stroke in the elderly. 15% of all strokes are associated with the arrhythmia, increasing to 36% in people over the age of 80. The prevalence of AF is higher in men at all ages, although the overall number of patients with AF is approximately equal between the sexes because of unequal death rates. In overall terms, approximately 50% of patients with AF are 75 or over, and over half of these are women.
Catheter and surgical ablation of cardiac arrhythmias
Catheter and surgical ablation of cardiac arrhythmias have evolved rapidly over the last 30 years. Catheter ablation of ‘simple’ atrial arrhythmias such as supraventricular tachycardias and typical atrial flutter is very successful and low-risk. Catheter ablation of atrial fibrillation (AF) is now also successful in restoring sinus rhythm for the majority of patients. The place of invasive treatment for ventricular arrhythmias in various contexts is also evolving.
Following implementation of the Department of Health’s Chapter 8 of the National Service Framework in 2005, there has been expansion of arrhythmia services in the UK. In 2010, the capacity of hospitals to treat these arrhythmias is growing rapidly, and perhaps the main barrier to patient access is the limited awareness among would-be referring physicians of which patients should be referred for such treatments. This review article outlines the ways in which arrhythmias can be treated by catheter and surgical ablation, and provides success and complication rates to help the reader determine when, and for whom, these treatments might be appropriate.
Risk stratification for stroke in patients with non-valvular atrial fibrillation – can we improve decision-making for optimal treatment?
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.
Atrial fibrillation: a significant risk factor for stroke
Atrial fibrillation (AF) is the commonest sustained arrhythmia, affecting 1.2% of the population, which equates to more than 600,000 people in England. The prevalence of AF increases with age, with 8.4% of the over-65 age-group affected and also it is increasing in incidence and prevalence.Each year there are 150,000 strokes in the UK. Nearly one in five (18%) of the people presenting with a stroke are in AF at the time of presentation, and one in six strokes are directly attributable to AF.
HDL cholesterol and cardiovascular risk: the case for intervention
Statin therapy, optimally applied, lowers LDL cholesterol and reduces cardiovascular risk by 30-50%. This leaves a residual risk that needs tobe addressed by other interventions. The well-documented strong, inverse relationship between cardiovascular risk and HDL cholesterolconcentration, at all levels of LDL cholesterol, suggests that there may be further benefits from raising HDL cholesterol – the HDL hypothesis.Definitive proof, however, awaits the results of ongoing major outcomes studies.
Patients with type 2 diabetes and metabolic syndrome – management recommendations for reducing cardiovascular risk
Patients with type 2 diabetes and metabolic syndrome – management recommendations for reducing cardiovascular risk – Richard Hobbs, Eleanor McGregor, John Betteridge
Diabetes mellitus, in particular type 2 diabetes but also type 1 diabetes after the age of 40, confers substantial cardiovascular risk. In people with diabetes, at least in those who have had the disease for a few years, and no history of coronary heart disease, the risk of myocardial infarction is similar to that in non-diabetic patients with manifest cardiovascular disease. Intensive management of cardiovascular risk factors is, therefore, widely recommended for individuals with diabetes.
Lipids and cardiovascular disease: is LDL cholesterol enough?
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide and its incidence is increasing as lifestyle habits from developed countries are adopted by the developing world. The incidence of diabetes is also increasing rapidly as an epidemic of obesity gathers pace.1 The epidemiology of CVD is uniform throughout the world as demonstrated in the INTERHEART study, which showed that 85-90% of population attributable risk is due to nine cardiovascular risk factors, of which 55% is associated with dyslipidaemia and 12% to previously diagnosed diabetes.2 The dyslipidaemia risk factor in INTERHEART was the ratio of the endogenous (expressed as apolipoprotein B or approximately as non–HDL cholesterol) to reverse cholesterol transport pathways (expressed as apolipoprotein A1 or approximately as HDL cholesterol levels).
EDITORIAL | Keeping up with two professions: medicine and literature
Like Chekhov, doctors have to find time for both medicine and literature – in our case, the latest research literature. Finding time to read all that is necessary to keep up-to-date is a real challenge for most GPs, especially those with a special interest in cardiology or diabetes, but helps by summarising the most important developments.
EDITORIAL | A fit body leads to a fit heart and reduced risk of CVD
We now recognise the brain as the seat of the psyche, but the functions of the mind are dependent on the whole body and the harmonious interaction of all its parts.” (Sir Frederick Walker Mott 1853-1926. British neurologist, psychiatrist and sociologist, quoted by W.S. Dawson in Aids to Psychiatry)
Testosterone and type 2 diabetes: the forgotten link
The recommendation by the National Institute for Health and Clinical Excellence (NICE)1 that men with type 2 diabetes should be assessed annually for erectile dysfunction (ED) may have far-reaching implications. Unfortunately, this is the only significant piece of NICE guidance not yet introduced into the GP Quality and Outcomes Framework (QOF) for 2010.1,2 Although NICE incorrectly classified ED as a neuropathic complication of type 2 diabetes (T2D) rather than a macrovascular, microvascular, endocrine and neuropathic process, the implication of the suggested full assessment of these men is important.
EDITORIAL – “Vote for the man who promises least; he will be the least disappointing-
Since the general election, we have seen a remarkable focus on reform and reorganisation. The coalition government’s proposals are really going to change management, governance and accountability throughout the NHS. GP commissioning is the centrepiece of these reforms, which will see the disappearance of centrally managed processes and performance targets.
Cutting the risk of death after acute coronary syndromes
Approximately 110,000 patients are admitted to hospital each year in the UK with acute coronary syndromes. What is the pathophysiology and how should these patients be managed in primary care?
