Volume 1, Number 2, July 2008

POPULAR
TOPICEDITORIALLeave nothing to chance
Professor Michael Kirby

EDITORIALThe European perspective
Professor Richard Hobbs

POPULAR
TOPICORIGINAL RESEARCHAmbulatory ECG monitoring in primary care
George Kassianos

Objective: Investigating symptoms suggestive of cardiac arrhythmia in primary care requires a strategy beyond the resting 12-lead electrocardiogram (ECG), as the test is generally only of use while the patient is experiencing discomfort during the recording. This study assessed the use of automated ambulatory ECG monitors in diagnosing cardiac arrhythmias.
Design: A retrospective review of patients at one general practice.
Participants: 52 consecutive patients (73% female; age 52+18 years, range 22 to 93 years) with symptoms suggestive of cardiac arrhythmia.
Method: Automated ECG was recorded for 24 hours. Patients were also given a diary to record symptoms. The ECG reports were examined at the end of the test and correlated with symptoms, patient notes, and history before a decision to refer to secondary care was made.
Results: Episodes (> 30 s) of tachycardia (> 120 bpm) were present in 52% of patients and bradycardia (< 50 bpm) in 19%. The most common supraventricular arrhythmia was atrial ectopics, detected in 52% of patients. Three patients (6%) were found to have atrial fibrillation (AF) during the 24-hour test. Ventricular arrhythmia was detected in 71% of patients, with an average ectopic rate of 28+88 per hour (range < 1 to 397 per hour). Overall, 73% of patients were symptomatic during the 24-hour test, with 10% experiencing symptoms on at least 10 occasions.
Conclusions: Use of ambulatory ECG in patients with symptoms of cardiac arrhythmia proved feasible and useful in primary care. Results were used as the basis of referrals for 50% of patients tested, and to inform initiation or changes of medication in a further 24% of patients.

ORIGINAL RESEARCHMeasurement of baseline total cholesterol: new data from The Health Improvement Network (THIN) database
Robin Thompson, Christopher O’Regan, Steve Morant, Berkeley Phillips, Seleen Ong

Objective: Current baseline cholesterol data in the UK are limited to values obtained from clinical trials or from surveys of the general population. However, baseline cholesterol data from the statin-treated population may be more appropriate when estimating the impact of alternative statin prescribing strategies. This study set out to determine the baseline cholesterol measurement before patients are started on a statin.
Design: Data from The Health Improvement Network were used to identify statin users. The baseline cholesterol measurement prior to the first prescription of a statin was recorded for 223,058 statin-treated patients, stratified by cardiovascular risk.
Results: The mean total cholesterol (TC) value for the primary prevention group was 6.57 mmol/L (standard deviation [SD] 1.19), whereas patients with pre-existing cardiovascular disease (CVD) and those with diabetes were found to have mean TC levels of 6.1 mmol/L (SD 1.16) and 5.9 mmol/L (SD 1.15), respectively. Overall, the mean TC (mmol/L) for the pooled statin-treated patient group was 6.3 mmol/L (SD 1.22).
Conclusions: This study revealed differences in the mean baseline cholesterol levels for different cardiovascular risk groups. Overall, the mean baseline cholesterol measurement of the statin-treated population is higher than that of the general population. These new baseline cholesterol levels in statin-treated patients should facilitate more detailed assessments of alternative statin-prescribing strategies and their impact on achieving treatment targets.

JOURNAL REVIEWJournal Review

POPULAR
TOPICTOPICAL REVIEWReducing the impact of vascular disease: the proposed Vascular Risk Programme for risk assessment and management
Kamlesh Khunti, Stephen L Hiles, Melanie J Davies

POPULAR
TOPICEVIDENCE REVIEWCardiovascular risk management series: 2 - Using guidelines as a framework for cardiovascular risk management
Susan Wells, Elinor Washbrook, Leif Erhardt

POPULAR
TOPICCASE REVIEWA case of severe aortic stenosis
Ahmet Fuat

This series of reflective case studies presents the history, examination and test results for ‘real life’ primary care patients, followed by assessment of the evidence indicating what constitutes best practice.

DRUG REVIEWStatin therapy for secondary prevention of coronary heart disease: an update (part 2)
Kausik K Ray, Lesley A Everett

TRIAL REVIEWThe HYVET study: answering the question of whether or not to treat hypertension in the very elderly
Sarah Jarvis

DEBATEThe metabolic syndrome: myth or clinically useful marker?
Professor Mike Kirby

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