Prof Rob Doughty Heart Foundation Chair Heart Health University of Auckland. Dr Fraser Hamilton. General Practitioner Heart Foundation Hamilton

Transcription

1 Prof Rob Doughty Heart Foundation Chair Heart Health University of Auckland Dr Fraser Hamilton General Practitioner Heart Foundation Hamilton 14:00-14:55 WS #49: Controversies in Cardiovascular Disease 15:05-16:00 WS #61: Controversies in Cardiovascular Disease (Repeated)

2 Controversies in Cardiology Professor Rob Doughty Heart Foundation Chair of Heart Health Auckland Heart Group, The University of Auckland And Green Lane Cardiovascular Service, Auckland City Hospital

3 Starbucks Trenta

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5 Coronary artery disease Cerebrovascular disease Peripheral vascular disease Mesenteric vascular disease Renal vascular disease Develop with background of risk factors

6 Individual Continuum of Cardiovascular Risk Primary prevention CV event Secondary prevention 1 st CVRA 2 nd CVRA i th CVRA CVRA X X X X

7 48 year old male Chief executive, active No medications Risk assessment Case 1 Non-smoker 2 units alcohol in the evening BP 138/88mmHg, BMI 28 LDL 3.1, HDL 1.0, Normal glucose and HBA1C Father MI age 62

8 Your current CVD risk is 4%. This is a mild risk

9 6 week history of burning central chest discomfort (not pain), typically when rushing upstairs or mowing the lawns. Otherwise feels well and does not get chest discomfort cycling. No abnormal physical findings on examination. Resting ECG reported as normal

10 What is the likely diagnosis? What should you do? Medication? which ones Cardiology referral?

11 updated_angina_action_plan_for_web.jpg

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13 Coronary Angiogram

14 The right coronary artery was stented Patient discharged the following morning on: Aspirin EC 100mg daily Clopidogrel 75 mg daily Atorvastatin 40mg daily Cilazapril 1mg daily Metoprolol CR 47.5mg daily

15 Comes to see you for review First questions why do I need these drugs? I hear statins are dangerous?

16 Cholesterol 1971 Japanese biochemist Akiro Endo developed first statin in 1971 Compound in tiny fungal spore

17 Daily Mail 2012

18 Case: Alternative Scenario Sunday morning, at gym on indoor rowing machine Develops tight central chest discomfort Presents to hospital with ongoing chest pain Diagnosed with acute MI

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20 Case: Alternative Scenario Sunday morning, at gym on indoor rowing machine Develops tight central chest discomfort Presents to hospital with ongoing chest pain Diagnosed with acute MI Primary stenting to right coronary artery

21 Uncomplicated recovery Discharged after 48 hours Aspirin EC 100mg daily Ticagrelor 90mg bid Atorvastatin 80mg daily Cilazapril 1mg daily Metoprolol CR 47.5mg daily

22 Uncomplicated recovery Discharged after 48 hours Aspirin EC 100mg daily Ticagrelor 90mg bid Atorvastatin 80mg daily Cilazapril 1mg daily Metoprolol CR 47.5mg daily 12 months later. What should you do?

23 High versus Standard Dose Statins High dose statins in 1 million people treated for 5 years prevent 35,000 CVD events NNT = 29 over 2 years for ACS or 5 years for stable pts Cannon et al. JACC 2006;48(3):438

24 Aspirin EC 100mg daily Continue for life Ticagrelor 90mg bid Stop after 1year Atorvastatin 80mg daily continue Cilazapril 1mg daily Continue, optimise BP Metoprolol CR 47.5mg daily Stop?

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26 To achieve high quality healthcare and improve patient safety, by 2014 New Zealanders will have a core set of personal health information available electronically to them and their treatment providers regardless of the setting as they access health services Minister of Health, Hon. Tony Ryall statement of direction to the newly formed National Health IT Board, Oct 2009

27 Discharge summary ACS STEMI Primary PCI RCA DES Dyslipidaemia

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29 Social Media Years to Reach 50 Million Users Radio 38 years TV Internet ipod 13 years 4 years 3 years

30 Social Media Years to Reach 50 Million Users Radio 38 years TV Internet ipod 13 years 4 years 3 years Facebook 200 million users in < 1 year

31 We don t have a choice on whether we do social media, question is how well we do it Erik Qualman author of Socialnomics

32 Social Media and Health Social media Social media is place to only address young people NO Fastest growing segment on Facebook is yr old women 620 breast cancer groups on Facebook (J Med Internet Res 2011;13(1):e16) 1,090,397 members Fund raising, awareness, patient support

33 Healthcare, health promotion and prevention needs to come to the consumer in a credible way, not the consumer search for it... Social Media and Health We no longer search for the news/products/services, they will find us via social media... Social Media Revolution 2 YouTube

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35 Stop Eating Pies