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Heart tsar sets out primary care CVD strategy

By Lilian Anekwe

The Department of Health's heart tsar has set out his priorities for raising standards in the management of cardiovascular disease in primary care.

Professor Roger Boyle, the DH clinical director for cardiovascular disease, highlighted four clinical areas in which GPs should be braced for increased scrutiny.

As Pulse revealed in June, GPs will be expected to prescribe warfarin to more patients with atrial fibrillation, to help improve the detection and management of the condition.

The push for greater warfarin prescribing is partly based on estimates by NICE, showing that approximately 40% of patients in whom warfarin is indicated are not receiving it, amounting to some 166,000 patients nationally.

GPs will also be expected to make greater use of the Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation, or GRASP-AF tool, to find patients with atrial fibrillation at high risk of stroke and to identify which patients would be suitable for anticoagulation.

A third ambition is to drive up the number of patients attending cardiac rehabilitation, as ‘only a minority of patients have access to cardiac rehabilitation and there is poor adherence to medication in patients with heart failure'.

‘Locally-defined initiatives that include joint working across primary and secondary care, the development of care plans, and improved self-management should be encouraged', Professor Boyle said.

The Department of Health also wants to see wider prescribing of generic statins – an area ‘where there remains unacceptable variation in the use of the more costly statins' – for conditions such as familial hypercholesteraemia.

And lastly, in hypertension, ‘there needs to be stricter adherence to the clinical guidelines in achieving adequate control. Improvements measured under QOF have reached a plateau over recent years and there remains a lot to be done.'

In an article written jointly with Professor Steve Field and other senior RCGP members in the August issue of the British Journal of General Practice, Professor Boyle said the increased pressure on GP performance was inevitable given the financial constraints on the NHS.

Professor Boyle wrote: ‘The impending financial climate will require a focus on other imperatives that have the potential to drive up quality and at the same time drive down longer-term spending in the NHS.'

Hypertension is often uncontrolled, heart tsar Professor Roger Boyle said Hypertension is often uncontrolled, heart tsar Professor Roger Boyle said