Making Best Practice, Every Day Practice
Peripheral arterial disease (PAD) forms part of the same generalised vascular disease as coronary heart disease and cerebrovascular disease. Recent National Institute for Health and Clinical Excellence (NICE) guidelines emphasise the importance of a standardised approach in primary care. The aims of this article are to provide an update for practice nurses, and to highlight the importance of asymptomatic PAD as an independent risk factor for cardiovascular morbidity and mortality.
Peripheral arterial disease (PAD) has had a lower profile than other vascular diseases, but it is moving up the agenda following recent publication of guidelines from the National Institute for Health and Clinical Excellence (NICE). Take a look at NICE’s priorities for implementation, and you will see that using the ankle brachial pressure index (ABPI) to check for PAD is set to become part of routine cardiovascular risk assessment in primary care.
Putting Prevention First, the national strategy for cardiovascular risk assessment for people aged 40 to 74 years, remains high on the healthcare agenda regardless of NHS changes. The “Cog Man” on the cover of the guidance and leaflets distributed to practices and pharmacies highlights the close links between the heart, brain, kidneys and diabetes and underlines the comprehensive nature of vascular risk assessment. In this article, we look at how to carry out an annual review in high-risk people with a cardiovascular risk score of 20% or higher but who do not have high blood pressure, diabetes, chronic kidney disease or atrial fibrillation.
The recent guideline from the National Institute for Health and Clinical Excellence (NICE) on the clinical management of primary hypertension enables us to provide evidence-based care to patients with high blood pressure (BP). The guideline provides a clear treatment algorithm, starting with A (an ACE inhibitor or angiotensin 2 receptor blocker) or C (a calcium channel blocker), depending on the age of the patient, then combining them if target BP is not reached and then adding in D (a diuretic) if required. This article uses a series of case studies to illustrate diagnosis and treatment based on the new guidelines.
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.
There is a profusion of guidelines and recommendations setting out targets for managing the risk factors associated with cardiovascular disease to help us manage our patients. But which ones should we follow? In this article, we compare the treatment thresholds and targets in these different recommendations, consider the reasons for the variety of targets and look at how to rationalise the selection of the targets for an individual patient.
The NICE guideline for chronic kidney disease (CKD) was introduced in 2008, with the aim of assisting practitioners both in primary and secondary care in the early identification and management of patients with evidence of kidney disease. However, some debate still exists surrounding the implementation of this guideline in everyday clinical practice. In this article, we sort out
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