Tag Archives: NICE

Although the guidelines for the assessment of acute chest pain are largely in keeping with modern practice, those for the assessment of stable chest pain of recent onset are controversial in denying a role for the exercise ECG.2 The guidance concerns only the diagnosis of obstructive coronary artery disease (CAD) causing angina (or “the diagnosis of angina” to use NICE’s incorrect terminology) and it does not consider management. It highlights the need for clinical assessment to determine the likelihood of CAD and places appropriate emphasis on the nature of the chest pain. This follows classical teaching in describing chest pain as typ

To address the question of increasing engagement with CR programmes in target areas, in 2009, I chaired a Steering Committee convened by Abbott Healthcare Products Ltd. (formerly Solvay Healthcare) called ‘Setting the Standard for Cardiac Rehabilitation’ (START). The Steering Committee advised that the existing Cardiac Networks in each region would be the best forum for disseminating information about changes in CR funding and standards of care in this field. Abbott Healthcare Products Ltd. kindly agreed to organise a series of meetings in the UK, held during 2009 and early 2010, with the aim of raising awareness of the importance of CR a

WHO definition The World Health Organization (WHO) defined CR in 1993 in a timeless way that is inclusive and sensitive to the psychosocial, biomedical, professional expertise and service delivery mode and location elements required of a contemporary CR service. “The sum of activities required to influence favourably the underlying cause of the disease so that (people) may by their own efforts preserve, or resume when lost, as normal a place in the community… …it must be integrated within secondary prevention services of which it forms one facet”.3 BACR definition This article reflects on how this definition dovetails with the BACR St

In fact, fewer than half of networks have ever benefited from Patient Choice Revascularisation Pathway monies, which were originally intended to support CR also.2 The START meeting in Birmingham in December 2009 was an opportunity to celebrate the innovative approach undertaken by the West Midlands’ Regional NSF Implementation Group for Cardiac Rehabilitation and Secondary Prevention, describing local CR pathway service standards against which West Midlands’ CR programmes could be audited to inform commissioning. The subsequent proportional allocation of ‘Patient Choice’ rehabilitation funding across Birmingham and the Black Country w

The service at Charing Cross was used as the model for EUROACTION, a randomised, controlled trial of a preventive cardiology programme, conducted in eight European countries, including the UK. This nurse-led multidisciplinary programme significantly improved the management of lifestyle and medical risk factors for cardiovascular disease prevention in coronary patients and patients at high multifactorial risk for developing heart disease.1 The principles of the EUROACTION programme were used to found The MyAction community programme, commissioned in 2008 by NHS Westminster as a model for preventive cardiology care for its residents. The Imperi

What is beneficial exercise? A prime question needs to be considered before furthering this discussion: what is meant by beneficial exercise? The benefits of exercise impact on all aspects of health – physiological, psychological and social. A study by Fox (1999) found that short bouts of any activity, even low-intensity activity that may not bring about a significant physiological risk factor change, if it is performed regularly, will provide psychological benefits to self-esteem and self-efficacy, and reductions in anxiety and depression.2 Angina patients engaging in regular walking on a similar premise to that expressed by Fox show signi

North West London To try and identify local barriers and share good practice, we have been regularly reviewing our cardiac rehabilitation (CR) services in North West London. Through this process we hope to increase the average uptake in a step-wise fashion from 50–60% to the national target of 85%.1 Lack of appropriately funded services and low staffing levels are real problems across the sector, unfortunately. Nevertheless, some innovative approaches to CR are taking place. The uptake of CR services after primary percutaneous coronary intervention (PPCI) for myocardial infarction has increased from 26% to 84% at Imperial College Healthcare

The new guideline, which covers the management of heart failure in adults in primary and secondary care, contains new and updated recommendations on diagnosis, pharmacological treatment, monitoring and rehabilitation. Key priorities for implementation in the guidance include: Referring patients with suspected heart failure and previous myocardial infarction (MI) to transthoracic Doppler 2D echocardiography and specialist assessment within two weeks. Measuring serum natriuretic peptides in patients with suspected heart failure without previous MI; referring those with very high levels of serum natriuretic peptides to urgent transthoracic Dopp

The guidance sets out a range of evidence-based recommendations for effective action to help reduce cardiovascular disease and make it easier to enable individuals to make healthy choices. It focuses mainly on food production and its influence on the nation’s diet, and it aims to change the cardiovascular risk factors faced by the UK population through regulation, legislation, subsidy and taxation or by rearranging the physical layout of communities. Dr Simon Capewell (University of Liverpool, UK) who is also vice-chair of the NICE Guidance Development Group, said: “There was a feeling that dietary interventions have been largely neglecte

They note that although cardiovascular deaths are declining, there were still over 40,000 patients with NSTEMI acute coronary syndromes admitted to hospital in England and Wales in 2009. With worrying increases in the incidence of key risk factors – obesity, diabetes, and the tendency for people to take less exercise – the management of these conditions remains a high priority. As its starting point, the guideline recommends that as soon as a diagnosis of unstable angina or NSTEMI has been made, and aspirin and antithrombin drugs have been offered, patients should be formally assessed for their individual risk of future adverse cardiovasc