Preventive Cardiology: A practical manual PDF
Preview Preventive Cardiology: A practical manual
Preventive Cardiology: A Practical Manual C.S. Jennings Cardiovascular Specialist Research Nurse Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London A.C. Mead Specialist Dietitian Imperial College Healthcare NHS Trust and National Heart and Lung Institute, Imperial College London J.L. Jones Specialist Physiotherapist Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London A.M. Holden Physical Activity Specialist Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London S.B. Connolly Consultant Cardiologist, Imperial College Healthcare NHS Trust Honorary Senior Lecturer, National Heart and Lung Institute, Imperial College London K.P. Kotseva Consultant Cardiologist Imperial College Healthcare NHS Trust, Senior Clinical Research Fellow, Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London and D.A. Wood Garfi eld Weston Chair of Cardiovascular Medicine National Heart and Lung Institute, Imperial College London 1 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2009 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2009 All rights reserved. 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Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misap- plication of material in this work. iii Contents Detailed contents iv Foreword viii Preface ix Summary of lifestyle, risk factor, and therapeutic targets xii Abbreviations xiv Part 1 Background and multidisciplinary family-based cardiovascular assessment 1 Rationale for preventive cardiology programmes 3 2 The nurse-led multidisciplinary team 19 3 Identifi cation and recruitment 33 4 Comprehensive multidisciplinary family-based cardiovascular assessment 39 Part 2 Application of the assessment fi ndings to manage lifestyle and cardiovascular risk factors 5 Changing lifestyles 105 6 Smoking cessation 117 7 Principles of dietary intervention 123 8 Physical activity and exercise 145 9 Principles of managing weight loss 167 10 Blood pressure, lipids, and glucose 179 11 Cardioprotective drug therapies 193 12 Erectile dysfunction 197 13 The health promotion workshop programme 203 14 Data management, quality assurance, and audit 209 Index 211 iv Detailed contents Foreword viii Preface ix Summary of lifestyle, risk factor, and therapeutic targets xiii Abbreviations xiv Part 1 Background and multidisciplinary family-based cardiovascular assessment 1 Rationale for preventive cardiology programmes 3 What is preventive cardiology? 4 What is a high-risk patient? 6 What is cardiovascular risk? 8 How to assess risk 9 JES4: SCORE risk estimation system 10 JBS2: CVD risk prediction chart 12 Why families too? 16 2 The nurse-led multidisciplinary team 19 The core team in a preventive cardiology programme 20 The role of the nurse in a preventive cardiology programme 24 The role of the dietitian and physiotherapist in a preventive cardiology programme 26 Role of the cardiologist, general practitioner, and other physicians 28 Input of other disciplines to the preventive cardiology programme 30 Conclusion 32 3 Identifi cation and recruitment 33 Priority groups for CVD prevention 34 The practicalities of recruitment 34 DETAILED CONTENTS v 4 Comprehensive multidisciplinary family-based cardiovascular assessment 39 Principles of the multidisciplinary assessment of high-risk families 40 Assessment of lifestyle 42 Assessment of smoking 44 Assessment of diet and weight 48 Assessment of physical activity and exercise 60 Assessment of other cardiovascular risk factors 78 Assessment of psychological and social factors 84 Family history of coronary heart disease 100 Part 2 Application of the assessment fi ndings to manage lifestyle and cardiovascular risk factors 5 Changing lifestyles 105 Changing lifestyles 106 An approach to facilitating behavioural change 110 6 Smoking cessation 117 The challenge of helping high-risk patients to stop smoking 118 Tobacco treatments 120 7 Principles of dietary intervention 123 Principles of dietary intervention 124 What is a cardioprotective diet? 126 Fats 128 Fish and oily fi sh 130 Fruit and vegetables 132 Carbohydrate and fi bre 134 Protein 136 Alcohol 138 Salt (sodium chloride) 140 Stanol and sterol esters 141 Dietary cholesterol 142 Dietary interventions to improve risk factors 143 vi DETAILED CONTENTS 8 Physical activity and exercise 145 Introduction to exercise programming 146 Exercise prescription and physical activity advice 147 Delivery of a supervised exercise component 148 Monitoring exercise intensity 154 Health and safety 163 Home exercise programming 164 9 Principles of managing weight loss 167 The causes of obesity 168 The principles of energy balance 170 Setting targets for losing weight 172 How to reduce calorie intake 174 Other interventions for obesity 176 10 Blood pressure, lipids, and glucose 179 Lifestyle modifi cation and the management of blood pressure 180 Treatment protocol for blood pressure 182 Treatment protocol for lipid management 186 Treatment protocol for glucose management 190 11 Cardioprotective drug therapies 193 Antiplatelet therapy 194 Beta-blockers 194 ACE inhibitors 194 Lipid lowering therapies 194 Calcium-channel blockers 194 Diuretics 194 Anticoagulation 195 12 Erectile dysfunction 197 Background 198 Assessment of the patient with ED 199 Management 200 DETAILED CONTENTS vii 13 The health promotion workshop programme 203 The health promotion workshop group 204 Learning outcomes of the workshops 206 Characteristics of the workshop facilitator 208 14 Data management, quality assurance, and audit 209 Clinical activity 210 Data quality 210 Audit 210 Index 211 viii Foreword Modern cardiovascular medicine has witnessed a transformation in the acute management of vascular patients, giving more years to life. However, salvaging the acutely ischaemic myocardium by primary angioplasty for example is important but already too late in the management of coronary patients. We need to address the underlying causes of the disease which precipitated the acute event in order to reduce the risk of recurrent disease. The watch word is prevention. All patients with vascular disease should be able to access a comprehensive preventive cardiology programme addressing lifestyle, risk factor management, and cardioprotective drugs. The multi-disciplinary team - nurses, dietitians, physiotherapists, physical activity specialists, occupational therapists, psychologists, pharmacists and others – need to work together with cardiologists and GPs to deliver such preventive care. This Care Manual in Preventive Cardiology serves the professional interests of all members of the team by giving practical advice on every aspect of prevention. Waiting until patients develop vascular disease will be too late for some and the preventive cardiology team should extend their services to those people who are at high risk of developing cardio- vascular disease in the community. Prevention is always better than cure. Professor Kim Fox ix Preface The European and British guidelines on cardiovascular disease prevention in clinical practice1,2 advocate that the care of all high-risk patients and their families should embrace all aspects of cardiovascular prevention and rehabilitation. High-risk patients are those who present with symptomatic atherosclerotic disease and those who are asymptomatic but at high total risk of developing atherosclerotic disease (see fi gure below). If preven- tion initiatives are to have the greatest impact and be cost effective, they should be targeted at these high-risk patients and their families. Asymptomatic individuals at risk of developing symptomatic disease People without disease Patients with symptomatic cardiovascular disease High-risk patients and their families require multidisciplinary support to achieve appropriate lifestyle change—quitting smoking, making healthier food choices, and increasing physical activity—based on behavioural models of change. Risk factor management in terms of controlling weight, blood pressure, lipids and glucose and the use of prophylactic drug therapies, such as aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhib- itors, lipid modifi cation therapy, and anticoagulants, is also an integral part of this approach. The traditional focus of cardiac rehabilitation on physical rehabilitation for coronary disease is gradually evolving into a more com- prehensive strategy for all atherosclerotic disease patients which addresses all aspects of lifestyle, the management of other risk factors and the use of cardioprotective drug therapies. Beyond those with established cardiovascular disease, the next chal- lenge is to reach those apparently healthy individuals who are at high risk of developing cardiovascular disease. Both the European and the British guidelines on cardiovascular disease prevention provide models for total risk estimation (see risk estimation charts in this manual).
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