Cardiovascular

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.

A primary care service for cardiovascular risk reduction in first-degree relatives of patients with premature coronary heart disease

Cardiovascular disease continues to be the leading cause of premature morbidity and mortality in the UK.1 Primary prevention not only is cost-effective but is endorsed as a priority by healthcare systems in the UK, and indeed globally. We describe here a targeted prevention service, which showed that the modifiable risk factors of obesity and overweight, smoking and low levels of high-density lipoprotein cholesterol were highly prevalent in first-degree relatives of patients with premature coronary heart disease.

Left atrial myxoma presenting as worsening dyspnoea with a distinct positional relief of symptoms

Worsening dyspnoea is a very common presenting complaint in the community; the causes varyhugely. We present a case of a patient with worsening dyspnoea and a positional change in hissymptoms who was found to have a left atrial myxoma.

Validating heart failure registers in primary care: a way to higher QOF payments and better outcomes

We hypothesised that practice heart failure registers may not be complete or robust due to patients not always being allocated the correct READ codes. We set up a project which improved practice heart failure registers. Ensuring practices have robust registers, by improving clinical coding in general practice, means more accurate prevalence levels can inform planning and commissioning of heart failure services.

Improving the diagnosis and management of aortic stenosis

Aortic stenosis (AS) is the commonest cardiac valve disease in developed countries, with aortic sclerosis affecting 26% of people aged 65 and over and severe AS occurring in 3% of people over 75 years. It will become more prevalent with the ageing population. Symptoms include dyspnoea and chest pain, but these are often missed so many patients are currently undiagnosed. Once symptoms occur, prognosis is poor, with average survival being only two to three years.Aortic valve replacement is the only effective treatment for severe, symptomatic AS and is recommended in both European and US guidelines, but many older patients with co-morbidities are currently considered unsuitable or too high-risk for open-heart surgery. The development of transcatheter aortic valve implantation (TAVI) offers an effective treatment option for these patients. Latest figures show the number of patients undergoing TAVI in the UK is below that recommended by the National Institute for Health and Clinical Excellence (NICE) and the rate in other European countries, indicating scope for increased referrals and use of this procedure to improve outcomes.

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