Patient details put on PCT website following bureaucratic muddle
Multiple large-scale population studies have shown strong links between cardiovascular disease, particularly diabetes, and erectile dysfunction.
In his excellent book, Professor Mike Kirby summarises the evidence, quoting well-conducted multi-centre studies, showing prevalence rates of 52 per cent1 in a primary care diabetic population, 63 per cent in a hypertensive population2, and over 50 per cent in patients suffering a recent myocardial infarction2.
Other studies have shown the severity of erectile dysfunction is a direct predictor of the severity of cardiovascular disease severity. All this data is overlooked in current QOF assessments.
QOF points are currently awarded for several annual assessments. The value of retinal screening, lipid lowering, detection of albumenuria, and tight control of hypertension cannot be disputed.
The value of routine annual assessment of foot pulses and tactile foot assessment remains unproven and yet quality points are awarded for ticking boxes that this has been done.
There is compelling evidence of the efficacy of modern therapy with PDE5 inhibitors in treating erectile dysfunction with clinical success in around 75 per cent of patients.
The success rate in diabetes is only 55 per cent3 and the response is worse the longer the duration of the diabetes and the more severe the complications.
Therefore screening systems that neglect the problem until the condition is so severe that embarrassed patients demand help increase the likelihood of unsuccessful response to therapy. Many of these patients are seen by their GP or nurse every three months and the opportunity for intervention is missed for many years.
Recent publications are showing that the oral therapies for ED are important cardiovascular drugs with benefits on endothelial function2, hypertension4, peripheral vascular disease and sildenafil has recently been licensed for pulmonary hypertension5 in the US. The benefits in terms of well-being, improvement in depression scores and enhanced quality of life6 for the man and his partner are also well-established.
It is difficult to believe the reason that ED is not included among the questions to be asked is a fear of medication costs. Ten years ago, when statins cost £30-£50 per month, we ignored data as to the benefits and adhered to conservative targets, which appear ludicrous today.
Now the costs are as low as £3 per month, the guidance is to get the levels as low as possible.
The first of the PDE5 inhibitors will be off patent in a few years and prices will drop considerably.
It is time to implement best clinical evidence for the benefit of our patients now. We live in an era of patient choice, so why not ask the patient the question and let them become involved in the treatment choice.
Dr Geoff Hackett
Medical adviser, Cannock Chase PCT and Consultant in Urology, Good Hope Hospital