Antiplatelet (usually aspirin) and anticoagulant (usually warfarin) treatments are available to reduce the risk of stroke in patients with atrial fibrillation (AF) but both have potentially harmful adverse effects and warfarin can be time-consuming and expensive to monitor. Guidance exists for choosing between treatments but is often insufficiently detailed to support an informed choice about the risk and benefits. Prescribers and patients are often left with a choice between aspirin or warfarin, and aspirin – which is perceived to be safer and easy to use – is often chosen. This article explores the evidence for aspirin and warfarin in preventing stroke in patients with AF, and describes how we should change the way that decisions about treatment are made.
Hypertension (high blood pressure) is estimated to affect 60-70% of people aged over 60 years of age and increases the risk of complications such as coronary heart disease, heart failure and stroke. Although it is well accepted that lowering blood pressure is crucial in reducing overall cardiovascular morbidity and mortality, the number of people whose raised blood pressure is reduced below target levels remains defiantly low. In this article, we review why so many patients fail to reach blood pressure targets and how we can improve this, including use of more than one antihypertensive.
The first of 3 interactive programmes providing practical answers about the use of insulin.
Jane Diggle and Hannah Beba help to 'demystify' insulin in primary care - what's stopping us and what do we need to know?
The second of 3 interactive programmes providing practical answers about the use of insulin.
Nicola Milne and Su Down take a look at how we can make the most of insulin - How to initiate and how and when to titrate?