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CORONARY HEART DISEASE (CHD)

A vascular disease in which the arteries supplying blood to the heart (coronary arteries) are narrowed by atherosclerosis. CHD leads to myocardial infarction, and is the most common cause of death in the UK (one in five deaths in men and one in six deaths in women). Death rates are higher in Scotland than the South of England, in manual workers than in non-manual workers and in certain ethnic groups. Mortality is falling, but morbidity is rising, e.g. among heart attack survivors who develop heart failure. See also cardiovascular disease, atherosclerosis

Prevention of coronary heart disease NICE Public health guidance (PH25) https://guidance.nice.org.uk/PH25

Coronary heart disease: mortality and morbidity statistics. Heartstats (BHF Statistics website) https://www.heartstats.org

Prevention

CHD is largely preventable by action to reduce known modifiable risk factors for atherosclerosis.

CHD risk factors             
Non-modifiable Modifiable                
Age and sex Smoking Obesity
Family history Hypertension Physical inactivity
Ethnicity Hyperlipidaemia Poor diet (inc. high salt intake)
Socioeconomic status Diabetes Excessive alcohol intake

Primary prevention

Primary prevention aims to stop heart disease developing in a population. The NHS Health Check programme seeks to identify and manage individuals aged 40–74 years at high risk of cardiovascular disease (CHD, stroke, diabetes and kidney disease).

NHS Health Check https://www.healthcheck.nhs.uk

NICE. Prevention of coronary heart disease Public health guidance (PH25) https://guidance.nice.org.uk/PH25

Risk assessment

Risk can be assessed using charts or on-line tools.

  • NICE CG67 (2008) Cardiovascular risk assessment and modification of blood lipids for primary and secondary prevention of cardiovascular disease
  • SIGN 97 (2007) Risk estimation and prevention of cardiovascular disease

Secondary prevention

Secondary prevention aims to halt progression of symptomatic CHD, e.g. angina, myocardial infarction. Evidence is strong that targeting people with CHD for risk-factor modification reduces the risk of recurrent CHD. Prevention measures

  • Lifestyle advice on diet, exercise, smoking cessation, alcohol intake.
  • Medication to further control hypertension, hyperlipidaemia and diabetes.

Training in cardiovascular disease risk assessment

eLearning distance learning from Education for Health. https://www.educationforhealth.org/shop.php/courses/135/cardiovascular-disease-risk-assessment

Cardiac rehabilitation

The Heart Manual is an evidence-based supported self-management cardiac rehabilitation programme for people with coronary artery disease, widely used in the UK and overseas. It is suitable for most patients who have/have had:

  • myocardial infarction/acute coronary syndrome/percutaneous

coronary interventions (PCIs)

  • angina (stable)
  • heart failure (NYHA classes 1 and 2)
  • implantable cardiac defibrillator (ICD)
  • coronary artery bypass graft (CABG)
  • angioplasty/stent.

The Heart Manual NHS Lothian 

CHD review

Every patient with CHD should be seen at least annually, with fasting blood results, urine test results and blood pressure reading. Ensure use of correct Read codes.

  • Assess/monitor symptoms and disease progression
  • Review results/findings.
  • Check risk assessment, using tool if appropriate (see Appendix)
  • Discuss/monitor lifestyle issues: increasing physical activity, smoking cessation, safe alcohol consumption, healthy diet; use correct Read code for lifestyle advice.
  • Review medication/check adherence
  • Offer seasonal vaccination/s.
  • Write management plan if appropriate.
  • Assess presence of depression.
  • Discuss concerns or worries (consider erectile dysfunction resulting from condition or medication)

British Cardiac Society www.bcs.com

British Heart Foundation www.bhf.org.uk

HEART UK - The Cholesterol Charity www.heartuk.org.uk

Chest, Heart and Stroke Scotland www.chss.org.uk

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