nmrcgp for consultants

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Cardiology

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

1. PRIMARY CARE MANAGEMENT

• Manage primary contact with patients who have a cardiovascular problem.
• Co-ordinate care with other primary care health professionals, cardiologists and other appropriate specialists, leading to effective and appropriate acute and chronic disease management including prevention and rehabilitation.
• Make timely appropriate referrals on behalf of patients to specialist services, especially to rapid access chest pain and heart failure clinics.
• Promote cardiovascular well-being by applying health promotion and disease prevention strategies appropriately.
• Describe strategies for early detection of cardiovascular problems that may already be present but have not yet produced symptoms

The knowledge base

Symptoms
Key issues in the diagnosis of cardiovascular problems will be eliciting of the appropriate signs and symptoms and subsequent investigation and / or referral of people presenting with:
• chest pain (Cardiac causes e.g. ischaemic heart disease, pericarditis and aortic dissection versus non-cardiac causes e.g. chest wall/musculoskeletal, psychological, respiratory)
• breathlessness (heart failure, respiratory problems, thromboembolism, anaemia, obesity, malignancy)
• ankle swelling (heart failure, thromboembolism, venous stasis, varicose veins, DVT, leg ulcers, lymphoedema, anaemia, obesity, malignancy, hypoproteinamia)
• symptoms or signs thought to be due to peripheral vascular disease (arterial and venous)
• palpitations and silent arrhythmias
• signs and symptoms of cerebrovascular disease
• collapse

Common and/or important conditions
• Coronary heart disease (angina, acute coronary syndromes, cardiac arrest)
• Heart failure
• Arrhythmias (Ectopic beats, atrial fibrillation & flutter, narrow & broad complex tachycardias, brady-arrythmias)
• Other heart disease (valve disease, cardiomyopathy, congenital)
• Peripheral vascular disease (arterial and venous)
• Cerebrovascular disease (stroke and TIA)
• Thromboembolic disease

Investigations
• Blood pressure measurement
• Electrocardiogram (ECG)
• 24 hour ambulatory blood pressure measurement
• Venous Dopplers and ABPI measurement
• Knowledge of secondary care investigations and treatment including echocardiography, 24 hour arrthymia monitoring, venography, invasive procedures such as angioplasty, coronary artery bypass grafting.

Treatment
• Treatment of people at risk from cardiovascular problems including specific management of raised blood pressure and lipids.
• Chronic disease management including specific disease management, systems of care, multidisciplinary team work for people with established cardiovascular problems and rehabilitation
• Communication with patients and their families and inter professional communication both within the PHCT and between primary and secondary care

Emergency care
• Acute treatment of people presenting with cardiovascular problems or symptoms thought to be due to cardiovascular problems

Prevention
This will involve the following risk factors
• Blood Pressure
• Lipids
• Smoking
• Other modifiable risk factors (including alcohol, exercise, obesity and diet)
• Fixed factors: age ethnicity, sex and family history
• Co-morbidities especially diabetes (cross ref to diabetes section)
• Combining Risk Factors – risk calculation and communicating risk

2. PERSON CENTRED CARE

• Identify the patient’s health beliefs regarding cardiovascular problems and either reinforce, modify or challenge these beliefs as appropriate.
• Recognise that non-concordance is common for many preventative cardiovascular medicines and respect the patient’s autonomy when negotiating management.
• Communicate the patient’s risk of cardiovascular problems clearly and effectively in a non-biased manner.
• Utilise disease registers and data recording templates effectively for opportunistic and planned monitoring of cardiovascular problems to ensure continuity of care between different health care providers.

3. PROBLEM SOLVING SKILLS

The knowledge base

Emergency care
• Acute treatment of people presenting with cardiovascular problems or symptoms thought to be due to cardiovascular problems

Prevention
This will involve the following risk factors
• Blood Pressure
• Lipids
• Smoking
• Other modifiable risk factors (including alcohol, exercise, obesity and diet)
• Fixed factors: age ethnicity, sex and family history
• Co-morbidities especially diabetes (See also the Metabolic Problems Curriculum Statement)
• Combining Risk Factors – risk calculation and communicating risk

Specific problem-solving skills
• Intervene urgently when patients present with a cardiovascular emergency e.g. myocardial infarction, stroke, and critical ischaemia.
• Demonstrate an understanding of the importance of risk factors in the diagnosis and management of cardiovascular problems.
• Demonstrate a reasoned approach to the diagnosis of cardiovascular symptoms (e.g. chest pain - see above) using history, examination, incremental investigations and referral.
• Calculation of Cardiovascular risk (moved from psychomotor skills)

4. COMPREHENSIVE APPROACH

• Prioritise interventions for multiple risk factors and symptoms of cardiovascular problems according to their severity and prognostic risk.
• Advise patients appropriately regarding lifestyle interventions according to their cardiovascular risk and level of disability.

5. COMMUNITY ORIENTATION

• Describe the rationale for restricting certain investigations and treatments in the management of cardiovascular problems e.g. open access echocardiography, Statin prescribing.
• Advise patients appropriately regarding driving according to their cardiovascular risk and DLA guidelines.

6. HOLISTIC APPROACH

• Appreciate the importance of the social and psychological impact of cardiovascular problems on the patient.
• Appreciate the importance of the social and psychological impact of cardiovascular problems on the patient’s family, friends, dependents and employers.
• Recognise the impact cardiovascular problems have on disability and fitness to work.
• Recognise the cultural significance that people attach to the heart as a seat of emotions.

All these 6 domains have a

7. Contextual Aspect

• Understand the current population trends in the prevalence of risk factors and cardiovascular disease in the community.
• Understand the key government policy documents that influence healthcare provision for cardiovascular problems.
• Recognise how geographical distance influences the treatment of cardiovascular emergencies.

8. Attitudinal Aspect

• Ensure that personal opinions regarding risk factors for cardiovascular problems (e.g. smoking, obesity, exercise, alcohol, age, race) do not influence management decisions

9. Scientific Aspect

• Understand and implement the key national guidelines that influence healthcare provision for cardiovascular problems.
• Describe the key research findings that influence management of cardiovascular problems (e.g. heart protection study)