Cardiovascular

How can we avoid a stroke crisis?

A report from a multidisciplinary alliance has made a compelling case for a coordinated planin Europe to reduce the health, social and economic burdens of stroke related to atrialfibrillation (AF). The group comprises eminent cardiologists, neurologists, a healtheconomists, hospital pharmacists, a haematologist and representatives from patientorganisations.How Can We Avoid a Stroke Crisis? has been endorsed by 17 medical and patientorganisations, including the European Primary Care Cardiovascular Society. Its aim is tohighlight to European policy makers the need to achieve earlier diagnosis and bettermanagement of AF across Europe, with the ultimate goal of reducing the risk of stroke inpatients with AF. The key points summarised in the report are shown in table 1.

Atrial Fibrillation In Primary care: Bringing practice closer to guidelines – a tool for primary care physicians

In the last few years we have witnessed a number of advances in the management of atrial fibrillation (AF). While these have created valuable opportunities to improve patient outcomes, we need to ensure physicians have the right support to deliver the most appropriate care. The AF AWARE (Atrial Fibrillation AWareness And Risk Education) campaign, working with a panel of AF experts, has developed the Atrial Fibrillation in Primary care (AFIP) tool – a ‘go to’ resource for primary care physicians, to help with the identification and management of AF, in line with the latest published guidelines. This article provides some background to the need for such a tool, and an outline of its content.

CT coronary calcium scoring: improving cardiac risk stratification

We describe the technique, application, risks and benefits of computed tomography (CT) coronary calcium scoring in relation to how it could be used in primary care to help produce an individualised cardiac risk assessment.

Current evidence for the management and early treatment of transient ischaemic attack

Transient ischaemic attack (TIA) is an important risk factor for stroke. Early recognition of symptoms and timely secondary prevention significantly reduce stroke risk. We review current evidence and guidelines for early management and treatment of TIA, including early antiplatelet therapy, specialist review, and recognition and treatment of other risk factors. The roles of carotid artery and brain imaging are also considered.

Screening for asymptomatic atrial fibrillation at seasonal influenza vaccination

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Its incidence rises with age: in the over-65s the prevalence is 4% but this rises to 8.8% in the over-80s. The prevalence of AF is on the rise due, in part, to an ageing general population and to increased longevity resulting from improved medical care. AF is clinically important because it contributes to the incidence of heart failure, stroke and overall cardiovascular mortality. In addition, when strokes occur in association with AF, patients suffer substantial mortality, disability and longer hospital stays compared to stroke patients without AF, leading to an increased financial and resource burden on the NHS.

Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management

The prevalence of many physical illnesses is increased in people with severe mental illness and accounts for around three quarters of all deaths; cardiovascular disease is the commonest cause of death. The level of screening for and management of diabetes and cardiovascular risk factors remains low but a straightforward yet systematic care pathway should go a long way towards reducing the health inequalities experienced by people with severe mental illness.

Recognition of post-stroke depression: a chance to improve outcomes

Depression is common after a stroke. All stroke patients should have their mood assessed. A range of evidence-based interventions may be used, and guidelines should be implemented since failure to treat depression leads to poorer outcomes in rehabilitation and recovery.

Retinal artery occlusion as a cause of sudden visual loss: a management strategy

Retinal artery occlusion (RAO) is a frequent cause of sudden, painless, monocular visual loss.Many patients with symptomatic RAO also have systemic vascular diseases that may increasethe risk of future ipsilateral hemispheric cerebral vascular events. For healthcare professionalswho assess patients with RAO, knowledge of the possible ocular and systemic causes may notonly improve the patient’s visual prognosis, but may also reduce its associated mortality andmorbidity by encouraging prompt and appropriate referrals.

Cardiovascular risk management: 8 Pharmacotherapy – improving the lipid profile

Epidemiological and clinical research has determined that lipids contribute substantially to cardiovascular disease (CVD) and that modifying the lipid profile has a significant impact on coronary events. These findings are reflected in continuously updated CVD management guidelines, which focus on low-density lipoprotein cholesterol (LDL-C) as the primary therapeutic target. The guidelines have further defined LDL-C levels to which patients should be treated. An individual’s eligibility for treatment, and their LDL-C treatment goal and intensity of therapy is determined by their absolute CVD risk. Lipid abnormalities can be partly modified by lifestyle changes, which are integral to reducing risk for all patients. However, as lipid goals are progressively lowered, many patients will not be able to achieve them using lifestyle changes alone and these patients usually require treatment with lipid-modifying drugs. This article aims to provide practitioners with a concise guide to managing lipids with pharmacotherapy, based on recommendations from six of the most up-to-date clinical practice guidelines for prevention of cardiovascular disease.

Pharmacy-based health checks – acceptable and feasible

Pharmacists in the ethnically diverse city of Leicester piloted Healthy Life Checks in inner-city pharmacies, forpeople aged 40-74. Pharmacists conducted checks including blood pressure, weight and glucose measurementand gave lifestyle advice. We present here the findings from semi-structured telephone interviews conductedwith pharmacists and service users.

Cardiovascular risk management: 7 Lifestyle changes to reduce cardiovascular risk

Epidemiological research has clearly established that many risk factors contribute to cardiovascular disease(CVD). Some of them are modifiable, and treatment decisions are based on the level of risk determined by risk assessment. Positive lifestyle changes are crucial to the prevention and management of CVD, and can result in substantial risk reduction. These changes can include smoking cessation interventions, acardioprotective dietary pattern and increased physical activity. However, lifestyle changes are challenging forboth the healthcare professional and the patient, and behavioural counselling and regular follow-ups are often required to overcome barriers, encourage adherence and assist in the achievement of long-term lifestyle goals.This article aims to provide practitioners with a concise guide to the role and impact of lifestyle changesbased on recommendations from six of the most up-to-date clinical practice guidelines for prevention ofcardiovascular disease.

National GPwSI in cardiology survey 2010

The first general practitioners with a special interest (GPwSI) in cardiology services were set up more than 10 years ago but there is little information available on the national level about service provision. The authors invited all GPwSIs in cardiology to complete a survey detailing their qualifications and experience, range of services provided, capacity and clinical governance. The results are presented here.

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