Making Best Practice, Every Day Practice
Everyone between 40 and 74 years of age is to be offered checks for vascular disease as part of the new Putting Prevention First programme. The aim is to identify vulnerability to vascular diseases, with the goal of preventing up to 9,500 heart attacks and strokes and saving 2,000 lives every year. Who will this programme target, and what will we need to do to put it into action?
Obesity poses a major threat to the nation’s health and a national strategy is required to stem the rising prevalence, decrease the morbidity and mortality from associated conditions, and reduce pressure on the National Health Service. Primary healthcare staff will be at the centre of any such approach. Practice nurse-led lifestyle clinics have demonstrated that clinically beneficial weight loss can be achieved with a structured approach to weight management. In this article, we explore the impact of obesity and best practice strategies to help patients lose weight.
Death rates from coronary heart disease (CHD) have halved in most industrialised countries since the 1970s and those in the UK by 44% over the last decade in people under 65. But death rates from cardiovascular disease have been falling more slowly in the UK compared to other countries, particularly in the younger age group. CHD deaths fell by 49% in men aged 55-64 but only by 30% in younger men aged 35-44 between 1994 and 2004 in the UK. In women, there was only a 20% drop in the 35-44 age group compared to a 56% fall in deaths in the older age bracket. Why are younger people doing so badly and what does this mean for their future?
Tessa, age 68, rarely attends the surgery. She arrives on a Monday morning, however, saying that she had a ‘funny turn’ over the weekend. “I couldn’t think straight and my words came out all wrong. My arm was tingling like no-one’s business so I took to my bed to sleep it off. I still feel a bit queer this morning so Pete said I should pop down and get checked over.” What could be the problem with Tessa and what should you do?
Smoking will be banned in public places in England and Wales next year, in line with bans already in place in Scotland and Ireland. PCTs are likely to experience an increase in demand from smokers accessing services to help them quit. It is estimated that there will be around a 50% increase over normal demand from three months before the date of implementation, with the government predicting that around 600,000 people will decide to quit as a result of the legislation. The seasonal nature of stop smoking attempts means that the period between January and April is already a very busy time. This article reviews what practices can do to ensure they are well prepared.
Calculating cardiovascular risk is at the heart of primary prevention – it gives us a practical way of assessing who we should be targeting with lifestyle changes and drug treatment to reduce the chance of them suffering a heart attack or stroke in the future. The new Joint British Guidelines make it very clear who we should be screening for CVD and how to calculate their risk.
Nearly 250,000 people die each year in the UK from cardiovascular disease (CVD), despite all the hard work of healthcare professionals. The new Joint British Societies’ Guidelines on Prevention of Cardiovascular Disease in Clinical Practice (JBS2), published recently by all of the leading societies working to reduce CVD in this country, take a ‘get tougher’ approach to further reduce CVD deaths. They widen the range of patients who should be included in primary prevention, in addition to setting lower targets for total cholesterol (4.0 mmol/L), low-density lipoprotein (LDL) cholesterol (2.0 mmol/L) and blood pressure (140/85 mmHg).
Aspirin is the most widely used long-term antiplatelet therapy, achieving benefits in patients with a range of cardiovascular conditions by blocking one of the blood clotting pathways. It is cheap and relatively safe, despite the possible risks of gastric irritation or bleeding. In this article, we explore what we know about aspirin, together with its pros and cons in patients with cardiovascular disease.
Cardiovascular disease (CVD) remains the single biggest killer in the UK, accounting for 39% of deaths in the UK. It is important to remember CVD is not just a condition of old age, accounting for 36% of premature deaths among men and 27% among women. Several major clinical trials have shown that lowering cholesterol significantly reduces cardiovascular events and deaths. But how low should we go? The recent Treating to New Targets (TNT) trial suggested that it might be much lower than previously thought. Results showed that lowering LDL-cholesterol levels in patients with stable coronary heart disease (CHD) substantially below current targets achieved a significant further reduction in cardiovascular events.
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