NHS Health Check appears neither equitable nor cost-effective

NHS health checks may be missing the point when it comes to offering the optimal interventions and preventing cardiovascular disease. Carl Heneghan Since 2009 the NHS Health Check programme in England has added considerably to GP workload and has proved to be controversial given the uncertainty about whether it adds value. A Cochrane review found […]

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NOACs: good for some perhaps, but not for all

  ‘More than ten years of use, there remains uncertainty as to which populations are most likely to benefit from NOACs.’ Kamal Mahtani Over the last ten years, prescribing of non-vitamin K oral anticoagulants (NOACs) has increased substantially. In the UK, an estimated 58% increase has been quoted with a nine-fold increase in anticoagulant costs. […]

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Should you treat resolved Atrial Fibrillation?

  Do patients with resolved AF have a higher risk of strokes, asks Jack O’Sullivan Patients with Atrial Fibrillation (AF) are five times more likely to have a stroke than patients without AF. AF can be reversed (sinus rhythm restored) via catheter ablation or cardioversion (either electrical or chemical). Patients can also spontaneously revert to sinus […]

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Overestimation of cardiovascular risk and what to do about it

  A New Zealand study sets new standards for predicting cardiovascular risk and questions the validity of pre-existing risk equations  Carl Heneghan Prevention of cardiovascular disease relies on identifying those most at risk. Most cohorts of patients were established many years ago with patients at higher risk. A recent prospective cohort study done in New Zealand representing primary care […]

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Undertreatment of mitral regurgitation

  “All evidence, especially our lifelong population-based data, point towards a substantial unmet need for treatment of mitral regurgitation.”  Jack O’Sullivan Despite being the most common heart valvular disease, it is unclear how often patients with mitral regurgitation are treated. This is concerning because early treatment is beneficial [1]. A recent study, published in the […]

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Evidence Watch: Can clinical decision support tools optimise anticoagulant therapy?

  High baseline adherence rates for guidelines recommendations means that a clinical decision support system makes only a small difference in clinical outcomes for atrial fibrillation patients.   Carl Heneghan The evidence for the association of atrial fibrillation with stroke risk is clear. However, there remain persistent levels of under treatment in clinical practice. Clinical decision […]

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