Making Best Practice, Every Day Practice
The updated NICE guideline on post-myocardial infarction care (CG 172) provides a benchmark for primary care. In this article, Ivan Benett and Jennifer Yung highlight the five key tasks for general practice in caring for someone who has suffered a heart attack.
Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of abnormal liver function tests. Current advice is simply to monitor patients’ liver function, but is this really correct? And how do we identify and manage people at risk of developing NAFLD?
Measuring blood pressure (BP) is one of the commonest tests we carry out in primary care – generally taking several measurements with a digital BP monitor on at least two clinic visits before diagnosing hypertension. Ambulatory blood pressure monitoring (ABPM) has traditionally been used in secondary care hypertension clinics, and in some larger general practices. But new guidelines from the National Institute for Health and Clinical Excellence are making ambulatory monitoring part of routine practice for the diagnosis of hypertension in primary care. What are the new guidelines recommending and why the change to ABPM?
An electrocardiogram (ECG) is a quick and non-invasive way of recording the heart’s electrical activity. One of its many uses is in the diagnosis of myocardial infarction, angina, and rhythm disturbances. Although the ECG is a simple and easy test to perform, it is vital to obtain the best possible recording because of its importance.
Around 2.9 million people in the UK have moderate-to-severe kidney disease. Estimated glomerular filtration rate (eGFR) can help to identify patients at high risk of cardiovascular disease (CVD) and improve the prevention and management of chronic kidney disease (CKD). In this article, we explain why it is important to detect CKD early, how eGFR is calculated and how to reduce risk in patients found to have impaired kidney function.
The association between body mass index (BMI) and mortality from both cardiovascular disease (CVD) and coronary heart disease (CHD) is well accepted. Individuals with high BMIs are also at increased risk of developing other conditions such as sleep apnoea, osteoarthritis, female infertility, varicose veins, gastro-oesophageal reflux and stress incontinence. BMI has been the gold standard for predicting health by measuring body weight in relation to height. However, although BMI may be helpful in estimating overall obesity, it is becoming increasingly apparent that waist-hip ratio, which estimates central obesity, is a more accurate predictor of the risk of health problems generally and CVD in particular.
The most common cause of chronic kidney failure is diabetes, which accounts for between 30 and 40% of all cases. Chronic kidney disease is a long-term condition usually taking between fifteen and twenty years to reach the final stages. Although 30% of all people with type 2 diabetes will develop some degree of kidney disease, only a minority go on to develop end-stage renal failure. In this article, we look at the benefits of early detection and treatment in slowing the progression of renal impairment.
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