CARDIOVASCULAR DISEASE


there follows a life-long journey filled with many challenges of tests, medication, treatment, rehabilitation and personal adjustment to this life- changing event (4)


.


What has been done so far? In 2007, the Department of health, Social Services and Public Safety (DhSSPS) in Northern Ireland began the development of a series of Service frameworks to set out explicit standards for health and social care. The Cardiovascular Service framework (CVSfw) was launched in 2009 as the first of these frameworks and sets in place 45 standards for good practice in the prevention and treatment of cardiovascular diseases in Northern Ireland(5)


. It states that


there are many determinants which impact on cardiovascular disease.


Circumstances experienced during the early years influence health and wellbeing into adulthood. Physical activity and eating habits developed from an early age often form lifelong patterns of behaviour.


living and working conditions also impact on health. Type of job, level of control and employment conditions are major factors. Educational achievement and income are also powerful influences on health. The environment where we live can provide access to open and green space, which plays an important part in physical activity patterns alongside available transport infrastructure (6)


.


After its first three-year implementation, a review was carried out and the framework was updated. The framework will continue to be subject to regular review and refinement in the light of new evidence.


In june 2011, the minister for health, Social Services and Public Safety announced that a review of the provision of health and social care services in Northern Ireland would be undertaken. Then, in December 2011, ‘Transforming your Care: A Review of health and Social Care in Northern Ireland’ was published. It made 99 proposals for change across the range of health and social care services (7)


.


The ban on smoking in enclosed public spaces in April 2007 also represents a landmark strategic initiative targeted at reducing


for those who are overweight or obese, we can suggest healthy lifestyle measure to help reduce a patient’s risk of heart disease (table 1).


Regarding patients’ BmI, the healthy range should fall between the 18.5 to 24.9 range and is measured by dividing an adult's weight in kilograms by their height in metres squared (10)


.


Through medicines management we can help patients to get the best out of their medicines and help with concordance. Risk factors for cardiovascular disease that can be modified include hypertension, diabetes, hypercholesterolemia and smoking.


with medicines management we can optimise the effectiveness of a patient’s medication in those with the above conditions. Through education, a pharmacist can help patients understand the rationale behind their medicines, any potential side effects of the medication, the benefits of the medication and the importance of adherence.


morbidity and mortality associated with cardiovascular disease.


What can we do as pharmacists? As pharmacists we are the most accessible of all healthcare professionals. This gives us the unique opportunity to engage with our patients without the need for an appointment. we have a pivotal role in the prevention of cardiovascular disease. As pharmacists, we can contribute to reducing heart disease through services such as smoking cessation, risk screening services and medicines management. we are in a great position to provide information and advice tailored towards individual needs.


Transforming your Care highlighted that there was to be an extended role for community pharmacy in the arena of health promotion. health Plus Pharmacy was developed to enhance the role of pharmacies in promoting public health. It offered a training and development program in public health to those who wished to apply for it.


The aim of this training is to help patients to look after their own health better by providing advice to prevent illness, to provide information on local services, and to refer when required. It also encourages self management and independence to help ensure there is a reduction in the number of people requiring hospital treatment (8)


.


Table 1: Table showing healthy lifestyle advice (9) • Eating less saturated fats, sugar and salt


• Increase the amount of omega-3 fat eaten (oily fish 2-3 times per week)


• Increase fruit and vegetable intake • weight reduction if obese • Reduction in energy dense/ convenient food and drinks


• Reduce alcohol intake to <21 units/week for men and <14 units/week for women


• Increase physical activity and a less sedentary lifestyle


These measures will go a considerable way to helping patients that already have heart disease and in those who may be at risk of heart disease. It is good advice for everyone to follow regardless of CV risk.


As pharmacists, we also offer easy access to health checks that can help identify a patient’s risk. These include: blood cholesterol checks, blood pressure checks and body mass index (BmI) measurements and all accompanied with expert advice.


Unless hypertension is newly diagnosed, blood pressure should be checked every six months to one year. Patients should have their cholesterol checked annually. Some people may know their most recent results, however, if the patient has no idea, encourage them to discuss this with their gP or nurse at their next visit.


Non-diabetic target for blood pressure is: systolic < 140 and diastolic < 85. Ideally it should be a minimum of lower than 150/90mmhg. for those who have diabetes, then the diabetic target for blood pressure is: systolic < 130 and diastolic < 80. Ideally it should be a minimum of lower than 140/80mmhg.


Regarding cholesterol the aim is to lower the value to below 5mmol/l or to achieve 30 per cent reduction from baseline cholesterol, whichever is greater. A statin may still be indicated even if baseline cholesterol is less than 5mmol/l.


when a patient is in, it gives the opportunity to provide appropriate advice and encourage attendance at gP or nurse clinics. If measurements are taken for the patient’s blood pressure and cholesterol and they are not within target ranges, consider if it is possible to optimise the therapeutic plan further and make recommendations to the gP or nurse. A brief look at the patient’s PmR will enable you to see if your recommendations have been tried before.


In conclusion, it is clear that, moving forward, the fight to improve the health of the nation with respect to cardiovascular disease is a high priority. Pharmacists are at the forefront of providing the care and support that patients with cardiovascular disease require. Through networking, pharmacists can contribute to the improvement of the nation’s health.


References 1. stroke, NI Chest heart and. NI Chest heart and Stroke Statistics. https://nichs.org.uk/about-us/statistics/. [Online] 2. Choices, NhS. NhS Choices CV Disease. http://www.nhs.uk/conditions/cardiovascular- disease/pages/introduction.aspx. [Online] 3. NI, health. health Survey Northern Ireland 2013/14, 2014/15, 2015/16. https://www.health- ni.gov.uk/sites/default/files/publications/health/ hsni-first-results-15-16.pdf. [Online] 4. heart Disease Improvement Programme Sept 11. Scotland, NhS. 5. DhSSPS. Service framework for CV health and wellbeing. https://www.health- ni.gov.uk/sites/default/files/publications/dhssps/ service-framework-for-cardiovascular-health- and-wellbeing-april-2014-march-2017.pdf. [Online] 6. hSCNI. Technical report on NICVSf. http://www.publichealth.hscni.net/sites/default/ files/Technical%20report%20final.pdf. [Online] 7. health, Dept of. Into to Transforming your Care. https://www.health- ni.gov.uk/topics/health-policy/transforming-you r-care. [Online] 8. hSCNI. health plus initiative. http://www.transformingyourcare.hscni.net/hea lth-plus-pharmacy-initiative-enhancing-the-role- of-community-pharmacies/. [Online] 9. Scotland, NhS. Pharmaceutical Care of people with coronary heart disease. http://www.nes.scot.nhs.uk/media/678320/chd _information-no_articles.pdf. [Online] 10. choices, NhS. what is Body mass Index. http://www.nhs.uk/chq/Pages/3215.aspx?Categ oryID=52. [Online]


PhARmACy IN fOCUS - 39


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