Complex Cases in Primary Care: Atherosclerosis

CLINICIAN RESOURCES

Clinician Fact Sheets: USPSTF Screening Recommendations

A series of clinician fact sheets on the Agency for Healthcare Research and Quality Web site summarize the screening recommendations of the United States Preventive Services Task Force for various cardiovascular conditions, including abdominal aortic aneurysm, coronary heart disease, and vascular disease. These fact sheets can be easily downloaded as a PDF and printed for clinicians’ reference: www.ahrq.gov/clinic/cvd

Concern About Diabetes Risk With Statin Therapy

Two recent large meta-analyses, which together evaluate 18 clinical trials that investigated cardiovascular benefits of statins and enrolled more than 120,000 patients, demonstrated a small, but significant, increase in the risk of incident diabetes with statin use.  However, new data presented at the American Heart Association 2012 Scientific Sessions suggest that the cardiovascular benefits associated with statin therapy outweigh the small increases in the risk of developing diabetes in this patient population: www.theheart.org/article/1476709.do

Aspirin and Cardiovascular Risk Reduction

Primary Prevention

The optimal use of aspirin for the primary prevention of heart attack and stroke is controversial.  Clinical decisions regarding the appropriate use of aspirin for primary prevention should account for patient-specific factors, but the optimal dose, effect of resistance, and role in the contemporary risk-reduction landscape remain unclear. To help guide clinical decision making, the Agency for Healthcare Research and Quality Web site provides a risk calculator to help clinicians determine whether the net benefit of aspirin therapy for the primary prevention of cardiovascular risk outweighs bleeding risk for both men and women: www.ahrq.gov/legacy/clinic/cvd/aspprovider.htm

Secondary Prevention

Data from the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey indicate that the rate at which aspirin is prescribed for the secondary prevention of cardiovascular events is suboptimal, as every patient without a contraindication should receive it. According to the investigators, "There is an important and urgent opportunity to engage all healthcare providers, particularly primary care providers, in a singular, simple intervention with the potential to prevent heart attacks and strokes and save lives."
Parekh AK, Galloway JM, Hong Y, et al. Aspirin in the secondary prevention of cardiovascular disease. N Engl J Med. 2013;368:204-205. www.nejm.org/doi/full/10.1056/NEJMp1213380

Smartphone Apps for Clinicians

Several smartphone apps are available that help busy clinicians with various aspects of patient care. For example:

Twitter

One in three adults have used the Internet to find information on a medical condition either they or a family member may have (http://pewinternet.org/Reports/2013/Health-online/Summary-of-Findings.aspx).  It is no surprise that those in healthcare are seizing the opportunity to reach patients.  Further, physicians, publishers of medical journals, and medical schools are increasingly using social media, especially Twitter.  In October 2012 Twitter reported at Health 2.0 in San Francisco that health-related tweets had increased by 51% in 2012 (http://gigaom.com/2012/10/08/twitter-courts-healthcare-but-cautiously).

Twitter has changed the way we interact in terms of both how clinicians chime in and how patients weigh in.  Twitter also changes the way we get the latest medical news.  One place to start is to “follow” trusted sources of information for breaking news and just-in-time pearls:

Go to http://twitter.com
Create an account
Search for others and click “follow” to begin viewing their twitter posts
A few suggestions:
@theheart.org for TheHeart.org
@annalsofim for the Annals of Internal Medicine
@jama_current for news from the Journal of the American Medical Association
@nejm for news from the New England Journal of Medicine
@aafp for news from the American Association of Family Practice

Want to know more about Twitter etiquette?  Refer to this classic blog posting, "The Elements of Twitter Style":  www.red-sweater.com/blog/1225/elements-of-twitter-style

PATIENT RESOURCES

American Heart Association Patient Education Web Sites

www.HeartHub.org

This patient-focused Web site includes a comprehensive set of resources on heart disease, risk assessment tools, lifestyle recommendations, and other related information to help patients understand factors that affect their cardiovascular health and steps they can take to make positive changes in their lives.

www.startwalkingnow.org

This Web site promotes a heart-healthy lifestyle by providing resources for patients to plan, track, and stick with a regular walking routine. It provides helpful tips for getting started, choosing the right attire and shoes, keeping people motivated, and connecting with others.

Patient Brochures: USPSTF Recommendations

The Agency for Healthcare Research and Quality, together with the Veterans Administration, developed patient brochures that outline the recommendations of the United States Preventive Services Task Force recommendations in various areas of cardiovascular health. These brochures provide basic medical information and offer a set of questions for patients to ask their healthcare professionals: www.ahrq.gov/clinic/cvd

Smartphone Apps for Patients

There are several useful smartphone apps available for download to help engage patients in cardiovascular risk reduction by providing resources that promote healthy lifestyle choices and track activity levels. For example: