Mandy Davies, Christine Thomson and their practice team from Elgin provide a ‘how to’ guide on setting up an innovative strategy for managing chronic heart failure, based on their programme that recently won an Innovation in Primary Care Award.
DEBATE – The argument against an HbA1c target of 6.5%
The argument against an HbA1c target of 6.5%Richard Lehman
The argument against an HbA1c target of 6.5%: Aiming for too low an HbA1c will achieve no additional benefit and may do patients harm.
DEBATE – How low is too low: should we be aiming for an HbA1c target of 6.5%?
How low is too low: should we be aiming for an HbA1c target of 6.5%? Brian Karet
The argument for: Studies consistently show the benefits of aggressive glucose lowering. What is the evidence supporting this approach?
What is the clinical trial evidence for the benefits of long-term statin therapy?
What is the clinical trial evidence for the benefits of long-term statin therapy?Alan Begg
Structured monitoring of patients with long-term conditions has become a major component of scheduled care and a GP’s workload. The length of time a patient should remain on a certain medication to prevent a further cardiovascular event is often controversial, and phrasing recommendations to reflect the often absent evidence base is a problem for guideline writers. Recommendations on length of treatment are often informed by the results of randomised trials carried out for a limited period of time rather than reflecting long-term use in a defined patient cohort. This review reflects on the clinical trial evidence for long-term statin treatment in both primary and secondary prevention.
Look before you leap: do patient care plans improve the secondary prevention of heart disease in general practice?
Look before you leap: do patient care plans improve the secondary prevention of heart disease in general practice?Mark Davis
Mark Davis reviews a recent primary care study assessing the impact that tailored care and care plans can have on the secondary prevention of heart disease. Murphy AW, Cupples ME, Smith SM et al. Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice. BMJ 2009; 339: B4220.
Managing patients with recent onset chest pain: what should we do?
Chest pain and discomfort are common symptoms that account for 1% of visits to primary care, 5% of visits to accident and emergency departments and 25% of emergency hospital admissions. Coronary artery disease (CAD) is one of many causes of chest pain and is the commonest cause of death in the UK. However, there are treatments available that can improve symptoms and prolong life, making prompt assessment and diagnosis essential. The National Institute for Health and Clinical Excellence (NICE) has recently published a new guideline on the assessment and investigation of patients presenting with acute chest pain suggestive of acute coronary syndrome (ACS) and stable chest pain suggestive of angina. It includes recommendations that will mean some changes to the way these patients are managed in practice. This article looks at how we can put these changes into action.
“Heredity sets limits, environment decides the exact position within these limits” – Edwin Carleton MacDowell, 1887-1973
This quotation, although made more than one hundred years ago, remains very true today. New evidence from the INTERSTROKE study, published recently in The Lancet, shows that ten risk factors – many associated with lifestyle – account for 90% of the risk of stroke.1 Analysis of data from 6,000 people, half suffering strokes and the other half matched controls, from 22 countries worldwide between March 2007 and April 2010, revealed these risk factors are: high blood pressure, smoking, waist-to-hip ratio (abdominal obesity), physical inactivity, diet, lipids, diabetes, alcohol intake, stress and depression, and heart disorders.
