Tag Archives: general practice

Introduction Heart failure with reduced ejection fraction (HFrEF) affects 3.5–7.0% of patients aged 65–75 years, and up to 11% of those >80 years. Heart failure with preserved ejection fraction (HFpEF) accounts for at least half of heart failure diagnoses. The current overall prevalence of HFpEF (also known as HF with normal ejection fraction – HFnEF) and HFrEF is estimated to be 4.9% and 3.3%, respectively. Prevalence is expected to rise with an ageing population. There are multiple interventions proven to prolong life in patients with HFrEF.1 General practitioners (GPs) in the UK are financially incentivised by the Quality Outcome

Introduction From December 2019, SARS-CoV-2, a novel coronavirus, sparked a global pandemic and rapid scientific responses to the new coronavirus 2019 (COVID-19) disease. Rapid identification showed the angiotensin-converting enzyme 2 (ACE-2) as the host receptor for SARS-CoV-2. Given this, concerns were raised that renin–angiotensin–aldosterone system (RAAS) inhibitors, such as ACE inhibitors and angiotensin-receptor blockers (ARBs), which may increase the expression of ACE‑2, could negatively influence COVID-19 outcomes. This led to significant media attention and anxiety about ongoing use of these medications. However, there has bee

Introduction In 1988 the ISIS-2 (Second International Study of Infarct Survival) study brought about a sea change in the management of the patient suffering a myocardial infarction (MI) and, in particular, those who had ST-elevation (STEMI) changes on their electrocardiogram (ECG).1 Prior to that landmark trial, general practitioners (GPs) were much more involved in the care of patients suffering MIs. They had to decide with what urgency the patient had to be admitted, or even if they would be admitted at all, in the light of how little could be done for the patient in hospital. The care provided has improved since then to the point that the

The Gospel of Matthew tells us, “…the last can be first…” Nowhere is this truer than the towering UK success of that fundamental cornerstone of cardiovascular prevention, cholesterol-lowering therapy. In 2002, BJC published a paper showing how far the UK lagged behind other countries in Europe when it came to prescribing lipid-lowering drugs.1 At the same time, a number of other very large UK surveys were published.2 All showed that the UK was the sick man of Europe, with limited statin prescribing in the face of a huge burden of cardiovascular disease. Figure 1. Coronary heart disease (CHD) mortality compared to statin sales: Aug

Introduction People with atrial fibrillation (AF) are five times more likely to have a stroke.1 AF is an increasing problem as our population gets older.2 It is, therefore, important to be able to identify this condition as early as possible, when intervention with anticoagulation can prevent stroke, as is recommended by the National Institute for Health and Care Excellence (NICE), in most cases.3 Several studies have attempted to identify the most effective way of screening for, or case-finding, AF.4-7 The gold standard for diagnosis of AF is a 12-lead electrocardiogram (ECG). However, the 12-lead ECG is an impractical diagnostic tool for a

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Background Cardiovascular diseases are the most common cause of premature death in developed countries. The National Service Framework for Coronary Heart Disease (NSF CHD)1 sets out national standards for the prevention, diagnosis and treatment of CHD including explicit recognition of the role of primary care teams. A further NSF chapter ‘Arrhythmias and sudden cardiac death’ was published in 2005,2 emphasising that patients with long-term conditions may be managed in primary care. It also highlighted better access to effective management of arrhythmias in all areas, including primary care. Cardiovascular diagnostic and monitoring equipm

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