Preventing Heart Disease
In order to prevent heart disease, doctors must recognise a patient at risk of developing problems and begin preventative treatment. A failure to do so could amount to medical negligence.
Primary prevention for heart disease
Primary prevention applies to people who are not already proven to have ischaemia heart disease or cerebrovascular disease, but who could be at risk of developing such diseases.
Secondary prevention refers to the routine prescription of medication to people who have already got established disease – such as stroke, coronary heart disease and peripheral heart disease.
Primary prevention therefore requires the consideration of a patient's risk factors, which include:
- Age
- High blood pressure
- Smoking
- High cholesterol
- ECG results
- Family history (this has only been included in calculations relatively recently)
Calculating the risk of heart disease
In order to accurately calculate the patient's risk of heart disease, GPs must insert data into a computerised risk calculator. These are commonly part of GP clinical systems. The percentage of risk is calculated by algorithms based on USA data (Framingham) and UK data (QRisk).
For instance, the GP will put in the patient's age, whether their immediate family had an early stroke/heart attack, whether the patient smokes/used to smoke, cholesterol levels (obtained via a blood test) and blood pressure readings.
Blood pressure is a particularly useful indicator and is something that can be frequently monitored to check if a patient is deteriorating. If a patient has three readings which exceed 160 systolic or 100 diastolic, he/she is deemed to have consistently high blood pressure. This requires regular monitoring and, if other risk factors are present, treatment.
Family history is another factor that needs attention. A first degree relative (such as a mother or father) affected by coronary heart disease under the age of 60 would normally be regarded as loading the risk by about half.
What treatment is needed?
If the risk of cardiovascular disease is above the defined threshold, treatment should be offered to the patient.
Ordinarily a patient will be prescribed aspirin and anti-anginal therapy such as a beta-blocker. A statin may also be prescribed, although it is acceptable to delay this pending the outcome of a hospital investigation as it is undesirable to start a patient on too many drugs at the same time.
Hospital investigation
A patient should then be referred to hospital for further investigations. If a patient is experiencing symptoms such as chest pain, a referral should be made to a rapid access chest pain clinic. Otherwise a referral to a cardiology clinic will suffice.
Further medication or treatment should be offered depending upon the results obtained by the hospital.
Failure to achieve an acceptable standard of care
If a GP, rapid access chest pain clinic, cardiology clinic or other hospital department fails to achieve this standard of care within a reasonable amount of time, causing the patient harm, there could be grounds for a claim. For example, a GP may fail to act upon a patient's risk factors, or a referral may be rejected by the rapid access chest pain clinic.
To find out if you or your loved one has been the victim of medical negligence, please get in touch with us today.
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