The online home for the primary care professionals managing patients with cardiovascular disease, diabetes and related diseases.

Friday, 30 October 2015
Heart failure (HF) is an important cause of morbidity, mortality and misery for patients. However, there are many ways to improve and extend the lives of people with HF, if clinicians are familiar with and apply the numerous traditional, less mainstream and more innovative evidence-based treatment options. This article reviews current best practice in the management of chronic HF and of acute decompensated HF, and considers recent insights, controversies and innovations in this important, fast moving field.
Category: Editorial
Topics covered:
Friday, 30 October 2015
The outlook is bleak for patients with untreated or suboptimally treated heart failure (HF). Conversely, optimising management (HF) improves patient survival and reduces hospital admissions. However, standards of care continue to vary, and many HF patients are still not receiving recommended therapy with disease-modifying drugs or specialist input to their care. Outcomes will only improve for all our HF patients if evidence-based clinical guidelines are implemented throughout the NHS.
Category: Editorial
Topics covered:
Thursday, 10 September 2015
The updated guideline on lipid modification from the National Institute for Health and Care Excellence (NICE), which was published in summer 2014, has continued to cause a great deal of controversy, both among health professionals and the general public. Now that the dust has settled just a little, it is time to review the messages of this guideline in detail rather than relying on the headlines.
Category: Editorial
Thursday, 30 July 2015
Alcohol has been identified as one of Public Health England's seven key priorities. After smoking and obesity, it is the biggest lifestyle risk factor for morbidity and mortality in the UK, accounting for 10% of disease and death. An estimated 9 million adults drink alcohol at levels detrimental to their health, with an estimated 1.6 million portraying signs of alcohol dependence. There is a misconception that drinking alcohol will only have a negative impact on health in those who binge drink or regularly get drunk. However, alcohol harms not only the individual drinker but also society as a whole, costing £21 billion a year, including annual direct costs to the NHS of £3.5 billion.
Category: Editorial
Thursday, 30 July 2015
Despite advances in management, heart failure (HF) remains a deadly clinical syndrome, with a five-year survival of 58% compared with 93% in the matched general UK population. In this comprehensive supplement, my colleagues provide excellent reviews of all aspects of chronic and acute HF, from epidemiology, through diagnosis, lifestyle interventions, pharmacological and device therapies to implementation of current guidelines. Rather than regurgitating the content of their articles, I would like to pick out some areas worthy of thought and discussion. I will discuss challenges to clinicians in the diagnosis and management of HF, diagnostic use of natriuretic peptides (NPs), newer medical therapies and their future use, device therapies, and implementation of the evidence base into clinical practice.
Category: Editorial
Topics covered:
Thursday, 30 July 2015
Heart failure (HF) was singled out as an emerging epidemic in 1997. Since then, rates have continued to rise and it remains a major public health problem with a prevalence ofmore than 23 million worldwide. HF is associated with significant morbidity, mortality and healthcare costs, particularly in the over-65s. Changes in the case mix mean morepatients are presenting with preserved ejection fraction, for which management is aimed to stop progression, relieve symptoms, eliminate exacerbations and reduce the mortality. Despite reductions in HF-related mortality, hospitalisations remain frequent and readmissions continue to rise. It is these admissions to hospital that put a financialstrain on the local health economy, and cause stress and anxiety for the patient and supporting family.
Category: Editorial
Topics covered:
Thursday, 30 July 2015
Heart failure (HF) is a complex clinical syndrome, characterised by symptoms including breathlessness, fatigue, reduced exercise tolerance and fluid retention. Signs and symptoms may be non-specific or difficult to elicit, and some primary healthcare professionals continue to lack confidence in their ability to identify patients with HF. A systematic approach to history-taking, examination and referral aims to help improve the accuracy of the diagnosis and ensure that HF patients are referred for specialist assessment and receive evidence-based therapies.
Category: Editorial
Topics covered:
Tuesday, 14 July 2015
Managing stroke risk in people with atrial fibrillation (AF) is critical. The introduction of the CHA2DS2VASc score has lowered the threshold for consideration of anticoagulation to prevent stroke in AF. This means potentially extra work for clinicians in assessing AF patients, and an extra cost to the NHS from more medication and monitoring. This study aims to quantify the increase in the numbers of people requiring anticoagulation with the newer risk assessment score. Method: The GRASP-AF tool was used to quantify the number of people categorised as high risk, using the CHA2DS2VASc score compared with the standard CHADS2 score. Population: An inner-city population from nine general practices within a single Clinical Commissioning Group (CCG), covering a population of 42,274 patients. Results: A total of 395 patients were found to have AF. In this study, 64% were categorised as high risk using CHADS2 compared with 87% on CHA2DS2VASc. This represents an increase of 35% in the numbers of people classed at high risk of stroke and needing to be considered for anticoagulation. Conclusion: There are significant extra costs to implementing the CHA2DS2VASc score, both in drug costs and extra work for primary care, which need to be managed within the local health system. The greatest benefit will be at an individual level. Some people who would have had a stroke will be spared that experience. Who those individuals are, we will never know.
Category: Editorial
Tuesday, 05 May 2015
A meeting report from the British Society for Heart Failure (BSH) 17th Annual Autumn Meeting, held in London on 27-28 November 2014.
Category: Editorial
Thursday, 19 March 2015
Since the publication in 2008 of the first NICE guideline on the diagnosis and management of chronic kidney disease (CKD), there has been concern that creatinine-based estimated glomerular filtration rate (eGFR) may not accurately identify people at increased risk–particularly in elderly populations. The updated NICE guideline, issued in July 2014, includes some important changes that take into account recent research into the prognosis of CKD.  Of particular relevance for GPs are changes to the diagnostic criteria and classification of CKD, which are described in this article.
Category: Editorial

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