D. Liew, K. Webb, J. V. Vugt, J. Bonnet, P. Clemmensen, C. Phillips
{"title":"Statin prescribing in Europe: A comparison of differences and potential impact on health outcomes","authors":"D. Liew, K. Webb, J. V. Vugt, J. Bonnet, P. Clemmensen, C. Phillips","doi":"10.3132/PCCJ.2012.052","DOIUrl":"https://doi.org/10.3132/PCCJ.2012.052","url":null,"abstract":"","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123882986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David J. Jones, T. Wong, Diana A Gorog, V. Markides
Atrial fibrillation is the commonest sustained cardiac arrhythmia, and has a significant impact on morbidity and mortality. It is a leading cause of stroke, and suitable thromboprophylaxis should be considered in all patients. Treatment is tailored to the individual. This article will review the management strategies for patients with atrial fibrillation, and discuss the roles of primary, secondary, and tertiary care.
{"title":"Atrial fibrillation: which patients should be managed in primary, secondary and tertiary care?","authors":"David J. Jones, T. Wong, Diana A Gorog, V. Markides","doi":"10.3132/PCCJ.2010.001","DOIUrl":"https://doi.org/10.3132/PCCJ.2010.001","url":null,"abstract":"Atrial fibrillation is the commonest sustained cardiac arrhythmia, and has a significant impact on morbidity and mortality. It is a leading cause of stroke, and suitable thromboprophylaxis should be considered in all patients. Treatment is tailored to the individual. This article will review the management strategies for patients with atrial fibrillation, and discuss the roles of primary, secondary, and tertiary care.","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130583946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How well are we doing in lipid management","authors":"R. Hobbs","doi":"10.3132/PCCJ.2010.008","DOIUrl":"https://doi.org/10.3132/PCCJ.2010.008","url":null,"abstract":"","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133131756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Assessing cardiovascular risk in the 10-minute consultation","authors":"Safia Debar, S. Lusignan, J. Kaski","doi":"10.3132/PCCJ.2009.058","DOIUrl":"https://doi.org/10.3132/PCCJ.2009.058","url":null,"abstract":"","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131178493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Most smokers want to stop smoking and intend to stop at some point, according to cross-sectional studies. Nearly half of all smokers expect not to be smoking in a year's time, but only two to three in every hundred actually stop smoking permanently each year. It is widely recognised that healthcare professionals have an important role to play in helping patients to stop smoking, but what is the best way to achieve this?
{"title":"Smoking cessation 1: Choosing the right pharmacotherapy for each patient","authors":"P. Aveyard, A. Parsons, R. Begh","doi":"10.3132/PCCJ.2009.004","DOIUrl":"https://doi.org/10.3132/PCCJ.2009.004","url":null,"abstract":"Most smokers want to stop smoking and intend to stop at some point, according to cross-sectional studies. Nearly half of all smokers expect not to be smoking in a year's time, but only two to three in every hundred actually stop smoking permanently each year. It is widely recognised that healthcare professionals have an important role to play in helping patients to stop smoking, but what is the best way to achieve this?","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131824796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Familial hypercholesterolaemia (FH) is a genetic disorder with high serum cholesterol levels, early atherosclerosis and a high risk of premature coronary heart disease. It is both under-diagnosed and inadequately treated in some people, although the statin class of drugs is effective in reducing both morbidity and mortality. Recommendations: The basis for a diagnosis of FH is an LDL cholesterol (LDL-C) level of greater than 4.9 mmol/L in an adult or 4.0 mmol/L in a child under 16, combined with either, or both, a family history or clinical signs (xanthomata). Diagnosis can also be made by a genetic test. Because of the high risk of coronary heart disease, adults over 18 years should be treated with a high-potency statin. Patients should be reviewed at least annually, including a review of cardiovascular symptoms or risk factors. Primary care physicians should have a low threshold of suspicion for referral to a specialist in cardiology. Women of childbearing age need particular advice regarding contraception and specialist care in pregnancy. Children should be referred to a specialist centre for treatment.
{"title":"A commentary on the NICE guideline on identification and management of familial hypercholesterolaemia","authors":"M. Seed, S. Humphries, M. Thorogood","doi":"10.3132/PCCJ.2009.053","DOIUrl":"https://doi.org/10.3132/PCCJ.2009.053","url":null,"abstract":"Background: Familial hypercholesterolaemia (FH) is a genetic disorder with high serum cholesterol levels, early atherosclerosis and a high risk of premature coronary heart disease. It is both under-diagnosed and inadequately treated in some people, although the statin class of drugs is effective in reducing both morbidity and mortality. \u0000Recommendations: The basis for a diagnosis of FH is an LDL cholesterol (LDL-C) level of greater than 4.9 mmol/L in an adult or 4.0 mmol/L in a child under 16, combined with either, or both, a family history or clinical signs (xanthomata). Diagnosis can also be made by a genetic test. \u0000Because of the high risk of coronary heart disease, adults over 18 years should be treated with a high-potency statin. Patients should be reviewed at least annually, including a review of cardiovascular symptoms or risk factors. Primary care physicians should have a low threshold of suspicion for referral to a specialist in cardiology. Women of childbearing age need particular advice regarding contraception and specialist care in pregnancy. Children should be referred to a specialist centre for treatment.","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122765251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Lusignan, T. Chan, H. Gallagher, J. Vlymen, N. Thomas, N. Jain, A. Tahir, Michael Nation, J. Moore, F. Reid, Kevin Harris, N. Hague
Background: Chronic kidney disease (CKD) is an important cause of mortality and morbidity, especially in people with cardiovascular disease. Interventions that can be delivered in primary care have the potential to slow the progression of the disease. People with CKD can be identified readily and reliably from GP computer systems. Objective: To report the baseline quality of CKD management. Method: Pseudonymised routinely collected data from a representative sample of 14 practices across Surrey were extracted as part of a quality improvement study. Results: The crude and adjusted prevalences of stage 3 to 5 CKD are 6.3% and 5.8%, respectively. More than twice as many females (8.8%) as males (3.9%) have this condition. Hypertension, diabetes, ischaemic heart disease and other cardiovascular disease and anaemia are much more common with deteriorating renal function. Conclusions: The reported prevalence is lower than suggested by previous studies but this may reflect the lower levels of cardiovascular disease associated with a healthier lifestyle in the Southeast. However, there is scope to further improve the quality of CKD management in Surrey. Programmes carefully targeted at high-risk groups could slow the progression of CKD and therefore reduce the need for renal replacement therapy.
{"title":"Chronic kidney disease management in southeast England: A preliminary cross-sectional report from the QICKD - Quality Improvement in Chronic Kidney Disease study","authors":"S. Lusignan, T. Chan, H. Gallagher, J. Vlymen, N. Thomas, N. Jain, A. Tahir, Michael Nation, J. Moore, F. Reid, Kevin Harris, N. Hague","doi":"10.3132/PCCJ.2009.034","DOIUrl":"https://doi.org/10.3132/PCCJ.2009.034","url":null,"abstract":"Background: Chronic kidney disease (CKD) is an important cause of mortality and morbidity, especially in people with cardiovascular disease. Interventions that can be delivered in primary care have the potential to slow the progression of the disease. People with CKD can be identified readily and reliably from GP computer systems. Objective: To report the baseline quality of CKD management. Method: Pseudonymised routinely collected data from a representative sample of 14 practices across Surrey were extracted as part of a quality improvement study. Results: The crude and adjusted prevalences of stage 3 to 5 CKD are 6.3% and 5.8%, respectively. More than twice as many females (8.8%) as males (3.9%) have this condition. Hypertension, diabetes, ischaemic heart disease and other cardiovascular disease and anaemia are much more common with deteriorating renal function. Conclusions: The reported prevalence is lower than suggested by previous studies but this may reflect the lower levels of cardiovascular disease associated with a healthier lifestyle in the Southeast. However, there is scope to further improve the quality of CKD management in Surrey. Programmes carefully targeted at high-risk groups could slow the progression of CKD and therefore reduce the need for renal replacement therapy.","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130388821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cigarette smoking is the most preventable cause of illness, death, and excess healthcare costs in the UK. Most smokers want to stop smoking and intend to stop at some point. In this third article in our series on smoking cessation in primary care, we look at the evidence for the use of nicotinic partial agonists, including cytisine, which is not yet available in this country, and varenicline, which is.
{"title":"Smoking cessation 3: Nicotinic partial agonists in smoking cessation - Varenicline and cytisine","authors":"P. Aveyard, A. Parsons, R. Begh","doi":"10.3132/PCCJ.2009.019","DOIUrl":"https://doi.org/10.3132/PCCJ.2009.019","url":null,"abstract":"Cigarette smoking is the most preventable cause of illness, death, and excess healthcare costs in the UK. Most smokers want to stop smoking and intend to stop at some point. In this third article in our series on smoking cessation in primary care, we look at the evidence for the use of nicotinic partial agonists, including cytisine, which is not yet available in this country, and varenicline, which is.","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127606057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dragging their feet: The cost of sub-optimal treatment for patients diagnosed with peripheral arterial disease.","authors":"G. Stansby, J. Belch","doi":"10.3132/PCCJ.2008.044","DOIUrl":"https://doi.org/10.3132/PCCJ.2008.044","url":null,"abstract":"","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130592962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
1 mL/min/year after the age of 40 in otherwise healthy individuals. Figure 1 shows how this age-related decline leads the ‘normal’ GFR (accurately measured by isotopic means) for individuals over 70 years to fall into the range where the equivalent estimated GFR (eGFR, which is calculated from serum creatinine, using a formula) would be compatible with a diagnosis of chronic kidney disease (CKD). This is why there is still debate about the implications of a low eGFR in the elderly. In certain individuals, however, glomerulosclerosis occurs either prematurely or more rapidly than expected as a consequence of systemic vascular disease. These individuals are then identified as having CKD. Glomerulosclerosis T he glomerulus is essentially a knot of blood vessels and there are about a million of them in each kidney. Appreciating that the kidneys are highly vascular organs is the key to understanding why their function is affected by systemic vascular damage, such as that due to hypertension, atheroma or diabetes. It also explains why they are a good place to look for evidence of early disease when assessing the overall health of a patient’s vasculature and their risk of future cardiovascular events. Glomeruli lose their function as part of the normal ageing process and healthy tissue is replaced by scar tissue. This process, known as glomerulosclerosis, causes the glomerular filtration rate (GFR) to fall by approximately Once started, CKD becomes a selfperpetuating condition (Figure 2). Initial reduction in the number of nephrons by whatever mechanism (for the purposes of this discussion, glomerulosclerosis caused by systemic vascular disease) leads to structural and functional changes in surviving nephrons. These changes are mediated by vasoactive molecules, notably the renin-angiotensin system (RAS), cytokines, and growth factors. Initially, the kidneys increase capillary flow to non-sclerosed glomeruli in an effort to maintain GFR. But this state of ‘hyperfiltration’ eventually causes intraglomerular hypertension and accelerated sclerosis of remaining nephrons. As the nephrons sclerose, the demands placed on surviving nephrons increase, accelerating their sclerosis in turn. DISEASE REVIEW
{"title":"The pathophysiology underlying chronic kidney disease","authors":"Robert Lewis","doi":"10.3132/PCCJ.2009.028","DOIUrl":"https://doi.org/10.3132/PCCJ.2009.028","url":null,"abstract":"1 mL/min/year after the age of 40 in otherwise healthy individuals. Figure 1 shows how this age-related decline leads the ‘normal’ GFR (accurately measured by isotopic means) for individuals over 70 years to fall into the range where the equivalent estimated GFR (eGFR, which is calculated from serum creatinine, using a formula) would be compatible with a diagnosis of chronic kidney disease (CKD). This is why there is still debate about the implications of a low eGFR in the elderly. In certain individuals, however, glomerulosclerosis occurs either prematurely or more rapidly than expected as a consequence of systemic vascular disease. These individuals are then identified as having CKD. Glomerulosclerosis T he glomerulus is essentially a knot of blood vessels and there are about a million of them in each kidney. Appreciating that the kidneys are highly vascular organs is the key to understanding why their function is affected by systemic vascular damage, such as that due to hypertension, atheroma or diabetes. It also explains why they are a good place to look for evidence of early disease when assessing the overall health of a patient’s vasculature and their risk of future cardiovascular events. Glomeruli lose their function as part of the normal ageing process and healthy tissue is replaced by scar tissue. This process, known as glomerulosclerosis, causes the glomerular filtration rate (GFR) to fall by approximately Once started, CKD becomes a selfperpetuating condition (Figure 2). Initial reduction in the number of nephrons by whatever mechanism (for the purposes of this discussion, glomerulosclerosis caused by systemic vascular disease) leads to structural and functional changes in surviving nephrons. These changes are mediated by vasoactive molecules, notably the renin-angiotensin system (RAS), cytokines, and growth factors. Initially, the kidneys increase capillary flow to non-sclerosed glomeruli in an effort to maintain GFR. But this state of ‘hyperfiltration’ eventually causes intraglomerular hypertension and accelerated sclerosis of remaining nephrons. As the nephrons sclerose, the demands placed on surviving nephrons increase, accelerating their sclerosis in turn. DISEASE REVIEW","PeriodicalId":308856,"journal":{"name":"Primary Care Cardiovascular Journal (pccj)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123702149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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