Cardiology

Evolocumab and Alirocumab for treating dyslipidaemia

There are two new guidelines from NICE on the use of Evolocumab and Alirocumab for treating primary hypercholesterolaemia (both familial and non-familial) and mixed dyslipidaemia. What are these drugs...

Sacubitril valsartan for chronic heart failure

This is a new guideline from NICE on when sacubitril valsartan should be used. Sacubitril valsartan is a combination drug. It includes the angiotensin 2 receptor blocker (ARB), valsartan. It also incl...

Routine pre-operative tests and blood pressure

These are two guidelines, but both on the topic of pre-operative testing, so they fit nicely together. I am just pulling out the points useful for us GPs. Pre-operative tests This is a new guideline f...

Nice | Edoxaban for preventing stroke and VTE in non valvular AF

This is a new guideline from NICE which advises that Edoxaban can be used for preventing stroke and VTE in patients with non-valvular AF who have one or more other risk factors such as:Heart failure...

Nice | Apixaban for the treatment of DVT and PE

This is a new guideline from Nice on apixaban. It has now been approved for the treatment of and secondary prevention of DVT and VTE. Now dabigatran, rivaroxaban and apixaban can all be used in AF, fo...

Nice | Rivaroxaban in Acute Coronary Syndrome (ACS)

This new guideline from Nice states that rivaroxaban can now be used after ACS with elevated cardiac enzymes. It should be used either with aspirin, or with aspirin and clopidogrel together.It decre...

Nice | Acute heart failure

This is a new guideline from NICE on Acute Heart Failure. This is really aimed at secondary care and does not add anything to what we would routinely do in general practice. One thing to remember is t...

Nice | AF and heart valve disease – self monitoring using home devices

This new guidance from NICE advises that 2 new devices have been approved for home monitoring in warfarin patients with AF or heart valve problems. They are surprisingly cost-efficient for self-monito...

Nice | Lipid modification in cardiovascular disease – primary and secondary prevention

This is a summary of the somewhat controversial updated guideline from NICE on lipids. You could probably only have failed to notice the uproar surrounding this is you'd been living on Mars for the la...

Nice | Atrial fibrillation

This is the updated guideline from NICE on atrial fibrillation. This guideline is very different overall to the last guideline, but it probably doesn't contain anything radical if you've been to any A...

Nice | MI secondary prevention

This guideline from Nice, updates the advice regarding the secondary prevention of MI. Much of the guidance is the same. The biggest change is regarding the use of antithrombotics. I have summarised s...

Acute Coronary Syndrome

This guideline from SIGN has been updated. There are a couple of interesting points in it that I was not aware of:Patients should be advised to take GTN at the start of angina pain, then up to 3 tim...

Apixaban in Atrial Fibrillation

This guidance is another new drug for the use in AF as an anticoagulant. It is a Factor Xa inhibitor and is more effective than warfarin. It hasn’t been shown to be more effective than Rivaroxaban and...

WatchBP Home A Device

This guideline advises that the WatchBP Home A Device is cost-effective. It is a blood pressure machine that can detect an irregular pulse. It is fairly sensitive and specific for AF. Any positive res...

Ivabradine in Heart Failure

This guidance is about using ivabradine in heart failure. It will only be started by specialist nurses, cardiologists, or GPSIs, but we will be responsible for continuing it, so it is worth knowing wh...

Rivaroxaban in atrial fibrillation

This guideline is for Rivaroxaban, which is a Factor Xa inhibitor and has been approved for use in patients with nonvalvular AF and at least one of the following risk factors (which equates to a CHADS...

Dabigatran in atrial fibrillation

This guideline lays out the criteria for the use of Dabigatran, a thrombin inhibitor. It can be considered as an alternative to warfarin in non-valvular AF if at least one of the following applies:P...

Nice | Ticagrelor for the treatment of acute coronary syndrome ACS

Ticagrelor is a PO drug which inhibits platelet aggregation. In combination with aspirin it is more effective than clopidogrel + aspirin at reducing the endpoint of MI or death from vascular events. I...

Bye-bye to bendrofluazide

This is a must read guideline! The main changes are: using Ambulatory Blood pressure monitoring (ABPM) to diagnose hypertension, using different cut off levels for treatment in the over 80s, using cal...

Stable angina

Overall, the main treatment of stable angina is not changed. What advice should you give patients with angina?Pacing activities and physical exertion – including sexual activity Prognosis and the li...