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Research

Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study

James P Sheppard, Kate Fletcher, Richard J McManus and Jonathan Mant
British Journal of General Practice 2014; 64 (618): e38-e46. DOI: https://doi.org/10.3399/bjgp14X676447
James P Sheppard
Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham.
Roles: Research Fellow
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Kate Fletcher
Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Birmingham.
Roles: Research Fellow
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Richard J McManus
Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford.
Roles: Professor
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Jonathan Mant
Primary Care Unit, University of Cambridge, Cambridge.
Roles: Professor
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  • Missed opportunities in Lifestyle interventions
    Amrit P Takhar
    Published on: 21 January 2014
  • Training in Preventive Cardiology
    Harald M Lipman
    Published on: 31 December 2013
  • Published on: (21 January 2014)
    Missed opportunities in Lifestyle interventions
    • Amrit P Takhar, GP partner

    This study highlights very well the missed opportunities for intervening in primary care and focuses on pharmacotherapy, as current data recording allows this to be measured more easily than monitoring advice and impact of advice given on lifestyle interventions. In general practice, there is a risk that we become "pharmaceutical physicians" and are measured on our prescription data and BP recordings. There is a range of...

    Show More

    This study highlights very well the missed opportunities for intervening in primary care and focuses on pharmacotherapy, as current data recording allows this to be measured more easily than monitoring advice and impact of advice given on lifestyle interventions. In general practice, there is a risk that we become "pharmaceutical physicians" and are measured on our prescription data and BP recordings. There is a range of data which support the notion that increasing physical activity and weight reduction if overweight has a powerful effect in cardiovascular risk reduction which can be equivalent to the benefit gained from prescribing statins and further BP lowering agents. Indeed increasing physical exercise was shown to have both an equivalent and an additive effect to statins.(1)

    We need a way to move away from relying on drugs and work with public health colleagues (now within local authorities) in facilitating changes in behavior. Clearly this is not a simple task but it does start with general practice being aware of the benefits of lifestyle change and then being supported in this task as clearly there is not sufficient resource for this type of intervention. It is much simpler to prescribe a drug which is then automatically funded within the prescribing budget.

    Another area we are not measuring within practices is the uptake of cardiac rehabilitation which has been shown to be more cost effective than many interventions such primary PCI, stenting, and coronary artery bypass. We have clear evidence that cardiac rehab is effective in reducing total and cardiovascular mortality and hospital admissions in people with coronary heart disease(2) and also reduces all-cause and cardiovascular mortality rates in patients after MI when compared with usual care, provided it includes an exercise component.(3)

    There is also research data that cardiac rehab significantly reduces hospitalisation for chronic heart failure and significantly improves quality of life and exercise tolerance for people with heart failure.(4)

    The key to cardiac rehab would seem to me that there is structured resource to ensure the adherence to guidelines both for pharmacotherapy and for lifestyle modification.

    References

    (1) Huseyin and Ioannidis. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5577

    (2) Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011; 7: CD001800

    (3) National Clinical Guideline Centre. Post myocardial infarction: secondary prevention in primary and secondary care for patients following a myocardial infarction (full guideline). 2013.

    (4) National Clinical Guideline Centre. Chronic heart failure: national clinical guideline for diagnosis and management in primary and secondary care. 2010.

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (31 December 2013)
    Training in Preventive Cardiology
    • Harald M Lipman, Executive Director

    The two articles in the January issue of the BJGP highlight important aspects of management of cardiovascular disease prevention.

    Missed opportunities in prevention of CVD in primary care - a comprehensive study(1) demonstrated the scope for improvement in assessment and treatment for prevention of CVD. Only one-third of all patients in the study were receiving optimal treatment.

    Effectiveness of general...

    Show More

    The two articles in the January issue of the BJGP highlight important aspects of management of cardiovascular disease prevention.

    Missed opportunities in prevention of CVD in primary care - a comprehensive study(1) demonstrated the scope for improvement in assessment and treatment for prevention of CVD. Only one-third of all patients in the study were receiving optimal treatment.

    Effectiveness of general practice based health checks(2) showed that preventive-based health checks are associated with statistically significant improvements in activities and significantly reduced proportion of patients remaining at high risk.

    If the results of both these studies are correct then the implication can be drawn that health checks must be universally implemented and health professionals who are engaged in undertaking them must be fully versed in preventive cardiology measures.

    There would appear to be scope for improvement in training in preventive cardiology for frontline healthcare professionals.

    International Cardiac Healthcare & Risk Factor Modification (ICHARM), a not-for-profit NGO, will in 2014 be teaching a 10 seminar training course in Preventive Cardiology in Bashkortostan, situated in Russia to the South West of the Ural mountains. Based on this course, International Cardiac Healthcare & RiskFactor Modification, endorsed by the WHO, will be publishing a teaching manual of preventive cardiology for primary care physicians and healthcare professionals in the UK.

    Maybe this manual and similar training courses in the UK and other countries might assist with achieving reduction in numbers of at risk people and improvement in their management.

    References

    1. Br J Gen Pract 2014; 64: 28-29.

    2. Br J Gen Pract 2013; 64: 30-31.

    ICHARM, The Dutch House, 77a Fitzjohn's Avenue, London NW3 6NY UK. Tel/Fax + 44 207 435 3074. E-mail: intcardiachealth@aol.com. www.i-charm.co.uk

    Conflict of Interest:

    Executive Director ICHARM

    Show Less
    Competing Interests: None declared.
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British Journal of General Practice: 64 (618)
British Journal of General Practice
Vol. 64, Issue 618
January 2014
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Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study
James P Sheppard, Kate Fletcher, Richard J McManus, Jonathan Mant
British Journal of General Practice 2014; 64 (618): e38-e46. DOI: 10.3399/bjgp14X676447

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Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study
James P Sheppard, Kate Fletcher, Richard J McManus, Jonathan Mant
British Journal of General Practice 2014; 64 (618): e38-e46. DOI: 10.3399/bjgp14X676447
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Keywords

  • antihypertensive agents
  • primary health care
  • primary prevention
  • risk
  • secondary prevention
  • statins

More in this TOC Section

  • Factors associated with potentially missed acute deterioration in primary care
  • Inequalities in health-related quality of life: repeated cross-sectional study of trends in general practice survey data
  • Natural history of non-bullous impetigo: a systematic review of time to resolution or improvement without antibiotic treatment
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