Volume 9, Number 1, January 2002

HOT
TOPICEDITORIALBritain: still the sick man of Europe?
Adrian JB Brady

Br J Cardiol 2002;9:7-9.

HOT
TOPICPRIMARY CAREObesity management in cardiovascular disease – a view from primary care
Peter Stott

Br J Cardiol 2002;9:47-48.

PRIMARY CAREA secondary prevention tool for use by primary care organisations
Chris Harris

Though the evidence for secondary prevention of cardiovascular disease is strong, the substantial benefits in terms of outcomes are often lost at practice level with competing clinical priorities and, at primary care group/trust level, with competing commissioning priorities. Our primary care trust has developed a secondary prevention tool that gives a clear picture of the benefits achievable with effective secondary prevention.

Br J Cardiol 2002;9:54-56.

HOT
TOPICREVIEWStroke rehabilitation
Marion Walker

The devastating consequences of stroke make rehabilitation a substantial challenge. The benefits of stroke units are well established; the collaborative work of the multidisciplinary team may be one of the most important factors. The evidence for the efficacy of occupational therapy is conflicting and a meta-analysis of community occupational therapy trials is under way. Greater physiotherapy input is associated with a reduction in death and deterioration. One third of all surviving stroke patients require speech and language therapy but most receive less than 45 minutes per week. More rehabilitation research needs to be conducted. In the absence of scientific evidence, expert opinion still has an important part to play in the rehabilitation process.

Br J Cardiol 2002;9:23-30.

REVIEWAmlodipine treatment in patients undergoing PTCA in the UK: a cost-effectiveness analysis
John J Doyle, Erik Thaulow, Bjorn Jorgensen, Roman Casciano, Julian Casciano, Zoe Kopp, Nick Marchant, Renee Kim

The objective of this analysis was to assess the health economic outcomes of treating patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with amlodipine over a four-month time period in the UK. The total expected costs were determined and compared for patients using amlodipine versus those on placebo following an initial angioplasty. A decision tree model was constructed to estimate these total expected costs. Clinical data for the model were obtained from the Coronary Angioplasty Amlodipine Restenosis Study (CAPARES). Clinical outcomes in the model included myocardial infarction (MI), repeat PTCA, coronary artery bypass grafting (CABG) and all-cause mortality. Resource usage and economic data for the model were produced through the use of a modified Delphi panel and various economic literature and databases. The adjunctive use of amlodipine with PTCA decreased the rate of all adverse clinical outcomes by 9.4%. This improved clinical outcome led to a decrease in overall four-month costs per patient using amlodipine of £204. The total expected cost per patient using amlodipine was £3,833 and the total expected cost per patient not using amlodipine was £4,037.

Br J Cardiol 2002;9:31-36.

REVIEWBiphasic positive pressure ventilation in acute cardiogenic pulmonary oedema
Nicola Cooper, Badie Jacob

Non-invasive positive pressure ventilation (NIPPV) may be used in the treatment of acute cardiogenic pulmonary oedema. It has been shown to reduce the need for intubation and to improve left ventricular function. Patients do not need to be admitted to intensive care but can be managed in a coronary care unit. Two cases are described in this article. The indications, contraindications and complications of NIPPV are described and a practical guide to its use is given.

Br J Cardiol 2002;9:38-41.

HOT
TOPICREVIEWManagement of overweight and obesity in patients with cardiovascular disease
Michael Schachter, Henry Purcell, Caroline Daly, Mary Sheppard

Overweight and obesity affect around half of the UK population, and are a serious public health problem. Obesity is associated with hypertension, dyslipidaemia, type 2 diabetes and a sedentary lifestyle, and has been shown to be an independent risk factor for development of cardiovascular disease. There are characteristic structural changes of the heart and vasculature in obesity. There is strong evidence that even modest weight reduction lowers cardiovascular risk. Dietary intervention, lifestyle advice and increased exercise are the initial strategy, but selected patients will require adjunctive treatment with anti-obesity drugs. In the absence of contraindications, orlistat is appropriate to use in obese patients with established cardiovascular disease, though sibutramine use is contraindicated in this population. Surgical intervention, such as gastric restrictive procedures, may be needed in severe obesity but there is a high complication rate among the morbidly obese and particularly in those who are also diabetic.

Br J Cardiol 2002;9:42-46.

REVIEWFax stretch
Andrew RJ Mitchell, Alistair KB Slade

Br J Cardiol 2002;9:49.

CASE REPORTSuccessful pregnancy following a peripartum cardiomyopathy
Oliver R Segal, Kevin Fox

Br J Cardiol 2002;9:50-52.