Cardiovascular

Reducing hospital admissions for patients with heart failure: the impact of a Local Enhanced Service

Managing heart failure requires a holistic approach: as well as optimal medical treatment, patients and their families need to have a sufficient understanding of the condition. There also needs to be a service to deliver this care. Heart failure affects about 0.5% of the population, depending on the age of the population, so each general practice has a manageable number of patients. However, the expertise and confidence needed to deliver optimal care to heart failure patients and their families are not widely held in primary care. There is largely a reliance on secondary care to provide community services, led by consultants and delivered by specialist nurses. Within this system patients are usually well served, but sometimes patients fall between the community service and general practice. In Central Manchester there is no community heart failure service. About one in five patients with heart failure were being admitted each year, indicating that heart failure management in the community needed to improve.

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.

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.

EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 2010

Managing patients with recent onset chest pain: key steps

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.

How to use the GRASP-AF tool to reduce stroke risk in patients

Treating erectile dysfunction safely and effectively

Erectile dysfunction (ED) and vascular disease share the same risk factors and commonly co-exist. The presence of ED in otherwise asymptomatic men is, therefore, often a useful early warning sign of silent vascular disease. This fundamental concept highlights the importance of ‘looking beyond the penis’ in the evaluation of the ED patient, and challenges practice nurses to consider ED and sexual activity as part of their routine evaluation of patients. Once diagnosed, there is a range of effective treatments for ED, and guidance on how to use them safely in patients with cardiovascular disease (CVD).

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).

What is the real role of anticoagulants in atrial fibrillation and stroke?

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.

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