80% Of GPs Believe Cardiac Arrhythmias To Be Widely Under-recognised And Often Untreated, New Research Shows, UK
The research indicated that there is high demand among GPs for clarity and accuracy of patient referral pathways, for those patients experiencing key symptoms of cardiac arrhythmia such as blackouts. Although blackouts are more likely to be the result of a cardiovascular condition3, it is estimated that up to 150,000 UK patients, predominantly children, have been misdiagnosed as having epilepsy.4 According to the survey, only one in four GPs would refer a patient with blackouts to a cardiologist or a GP with a special interest in cardiology.1 Instead patients are referred to neurologists or age-specific physicians such as paediatricians. Professional guidance is available,5,6,7 however research showed that 63 percent of GPs were not aware of any specific guidelines.1
A new online module has today been launched by doctors.net and supported by the Arrhythmia Alliance which is available here.
The module aims to try to improve understanding of cardiac arrhythmias and focuses on key areas such as diagnosis, treatment and current Department of Health recommendations outlined in the National Service Framework (Chapter 8).2 Professor John Morgan, Professor of Cardiology at Southampton University, commented, "Primary care is vital for the effective management of cardiac
Distributed by Cohn & Wolfe on behalf of Medtronic UK arrhythmias. As such, educational needs amongst GPs must be addressed to ensure that patients with potentially fatal arrhythmias are being accurately referred and receiving the care they require."
Trudie Lobban, Founder and Trustee of Arrhythmia Alliance (The Heart Rhythm Charity, http://www.arrhythmiaalliance.org.uk) comments, "This research highlights the importance of ensuring there are effective service provisions such as rapid access clinics that can act as a triage tool, to ensure accurate diagnosis, treatment and correct referral in patients with cardiac arrhythmia. The results have shown that most GPs would refer patients to such clinics for suspected arrhythmias if they were aware of them."
Atrial fibrillation, the most common type of cardiac arrhythmia, is also acknowledged within the Quality and Outcomes Framework (QoF), with a significant 30 points rewarded for correct diagnosis and treatment.8 The low level of confidence in ECG readings identified in the research also suggests that many GPs may be missing this opportunity to increase valuable QoF points which could be easily gained through improved diagnosis and monitoring of patients.
Notes
The Cardiac Arrhythmia Survey1 and Doctors.net Arrhythmia module have been developed with the support of the Arrhythmia Alliance and sponsored by an educational grant from Medtronic Ltd.
NICE
Quick reference guide
Atrial fibrillation, June 2006 - The management of atrial fibrillation5
Next review date: June 2010
The NICE guidelines have a number of key priorities for implementation on the diagnosis and treatment of atrial fibrillation (AF). All patients that have had an irregular pulse detected should have an electrocardiogram (ECG) performed.
Treatment of patients with persistent AF will require either an initial rate-control or rhythm-control strategy, however each strategy must be explained to patients before agreeing which to adopt. Any co-morbidities that might indicate one approach rather than the other should be taken into account and appropriate antithrombotic therapy should be used in both approaches.
Patients suffering from permanent AF that need treatment for rate-control should be prescribed beta-blockers or rate-limiting calcium antagonists as the initial monotherapy, whereas digoxin should only be considered in predominantly sedentary patients.
In patients with newly diagnosed AF for whom antithrombotic therapy is indicated this should be initiated with minimal delay after the appropriate assessment of co-morbidities and risk of stroke and thromboembolism.
British Heart Foundation
Arrhythmias and Sudden Death - implications for GPs6
Factfile 2006
All unexplained sudden death in people over the age of 30 and all sudden deaths under 30 should prompt cardiovascular evaluation of parents, siblings and offspring. Most of the conditions which cause young sudden deaths are genetic and inherited, up to 50% of first degree relatives will be at risk. Targeted evaluation of those with arrhythmia symptoms and those with a family history will provide information which can lead to prevention of additional young sudden deaths.
The recent National Service Framework Chapter on Arrhythmia & Sudden Death recommended that families of young sudden death victims should undergo cardiac evaluation including ECGs, with an expert in inherited cardiovascular disease.
http://www.bhf.org.uk
European Society of Cardiology
ACC/AHA/ESC Guidelines
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text7
These are extensive guidelines that state that a minimum clinical evaluation of patients with AF must involve a history and physical examination, an ECG and blood tests for thyroid, renal and hepatic function. The guidelines also include proposed management strategies that consist of rate control, prevention of thromboembolism and correction of rhythm disturbance.
These strategies are broken down into the treatment of newly diagnosed recurrent or paroxysmal arrhythmias and permanent or persistent arrhythmias.
http://www.escardio.org
References
1. Cardiac arrhythmia survey - data from a study conducted by medeConnect Healthcare Insight, part of the doctors.net.uk group
2. Department of Health, Chapter 8
3. Fitzpatrick, A; Cooper P. Diagnosis and Management of Patients with Blackouts. Heart 2006; 92: 559-568
4. Petkar, S., Jackson, M., Fitzpatrick, A. Management of blackouts and misdiagnosis of epilepsy and falls. Royal College of Physicians Journal : vol 5 :September/October :Conference reports
5. Atrial fibrillation, June 2006 - The management of atrial fibrillation
6. Arrhythmias and Sudden Death - implications for GPs Factfile 2006
7. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text
8. Quality and outcomes framework guidance - atrial fibrillation
http://www.escardio.org
80% GPS Crede aritmii cardiace Pentru a fi recunoscut pe scarã largã Sub-ºi, adesea, netratat, New Cercetãrile aratã, Marea Britanie - 80% Of GPs Believe Cardiac Arrhythmias To Be Widely Under-recognised And Often Untreated, New Research Shows, UK - articole medicale engleza - startsanatate