Coronary Heart Disease Medication.ppt

CHD - so who do we mean and what should we look at? Established - post MI, CABG, ischaemic stroke / TIA, angina, AF, PVD Heart failure Hypertension (Diabetes) Raised cholesterol, obesity, smokers Intervention + review based on current status, risk factors, existing treatment Targets in the GMS contract CaseIt is a busy day in your practice and you are sitting at your desk, legs up, leafing through a recent issue of Diversion, The Magazine for Physicians at Leisure. You come across an ad for Plavix,TM which states that this medication reduces the risk of cardiovascular events by 9% compared to aspirin. You wonder if you should be switching all your patients to Plavix. TM Primary prevention: statin therapy [NICE 2008] Offer statin therapy for adults who have a 20% or greater 10-year risk of developing CVD Initiate treatment with simvastatin 40?mg If simvastatin 40 mg is contraindicated, offer a lower dose or alternative preparation (such as pravastatin) A target for total or LDL cholesterol is not recommended Secondary prevention: statin therapy [NICE 2008] Offer statin therapy to adults with clinical evidence of CVD Offer higher intensity statin to people with acute coronary syndrome, taking into account: the patient’s informed preference comorbidities multiple drug therapy, and the benefits and risks of treatment Secondary prevention: statin therapy continued Treatment should be initiated with simvastatin 40?mg If simvastatin 40 mg is contraindicated, offer a lower dose or alternative preparation (such as pravastatin) If total cholesterol of 4?mmol/litre or LDL cholesterol of 2?mmol/litre is not attained consider simvastatin 80?mg (or similar) Targets for PCT Advisers Better Care Better Value Statins Generic Prescribing National Audit Office Proton Pump Inhibitors ACE inhibitors / Angiotensin 2 Receptor Antagonists Antiplatelets Other important cost areas Drugs used in diabetes Respiratory corticosteroids Analgesics Hypertension and He