With the proliferation over the past few years of GPs with an interest in cardiology, I found it curious that a book on the prevention of cardiovascular disease in primary care should be co-authored by specialists in secondary care.
It is clear that preventive healthcare is the remit of primary care, but how can we get a balanced view of the need for action by GPs from practitioners not working in the field?
The chapters on the organisation of preventive services in primary care seemed to be being viewed from a distance, with little mention of the 'patient-led NHS' and 'practice-based commissioning'. This rapidly evolving environment concerns and involves all practitioners in primary care.
However, as I progressed through to the more specific areas of preventive medicine, working through risk assessment and specific pathological conditions, the wealth of well-presented information just worked to impress.
In an area that many would suggest is dull and difficult to understand, Handler and Coghlan have produced a readable text with accessible information on every page.
The value of the methods of assessment, from individual monitoring of the patient to the screening of populations, are well discussed and the benefits laid out in easily accessible forms. The frequent summary boxes draw the eye to relevant tracts of text.
As the national agenda is moving to primary cardiovascular risk assessment, clinical leaders in individual practices and within PCT structures are going to need a working knowledge of the evidence base and the size of the issues. Handler and Coghlan have prepared a text which can assist. This handy reference will be invaluable to doctors, nurses and commissioners as these developments move forward.
As a GP with an interest in the stroke risks of AF, I was concerned that this area seemed to have been overlooked. I appreciate that this does not clearly fall under the remit of primary prevention, but it is a major contributor to patients' risk of stroke and a substantial cost to both the health and social budgets. Personally, I would think it worthy of more than the scant attention given.
However, this could be seen as nitpicking, as the text deals well with a variety of influences on vascular disease, from medical issues such as the influence of diabetes and metabolic syndrome to the more social issues of obesity, smoking and diet.
Handler and Coghlan devote many pages to exploring the evidence and the issues in an easily accessible text.
As an overall assessment I would commend this book not only to clinical practitioners but to managers and commissioners, who have to deal with the cardiovascular primary prevention agenda. It is an easily accessed review of the problems, in a well laid out and comprehensive guide.
- Dr Fay is a GPSI in cardiology and national primary care lead in AF, Shipley, West Yorkshire
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