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Cardiovascular system

An update on managing patients with atrial fibrillation

Most patients with atrial fibrillation can be managed in primary care. Patients should be referred for an initial assessment with... View Article

August 2017

The safe and effective use of dabigatran and warfarin in primary care

Patients taking oral anticoagulants require appropriate management in order to receive the maximum benefit from treatment with... View Article

August 2017

Beta-blockers for cardiovascular conditions: one size does not fit all patients

Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand. There is, however, little... View Article

July 2017

Targeted testing for abdominal aortic aneurysm

A recently published study from the University of Otago provides clarity as to which patients in general practice would benefit... View Article

October 2016

Amiodarone brand-change and a reminder on patient monitoring

Two brands of amiodarone are currently subsidised in New Zealand; Aratac (a generic brand) and Cordarone-X (the innovator brand). View Article

October 2016

Out-of-clinic blood pressure testing in primary care

Out-of-clinic blood pressure monitoring is increasingly regarded as a routine component of cardiovascular risk management. This... View Article

May 2016

Managing patients with type 2 diabetes: from lifestyle to insulin

The management of type 2 diabetes is multi-faceted. Following diagnosis, patients require education to self-manage their condition... View Article

December 2015

Research Update: Testosterone use and cardiovascular risk in older males

In the previous edition of Best Practice Journal, we covered the appropriate use of testosterone in older male patients (see:... View Article

September 2015

A follow-up to acute coronary syndromes

The article: "The immediate management of acute coronary syndromes in primary care” attracted some interest from emergency care... View Article

August 2015

The role of prophylactic antibiotics for preventing infective endocarditis in people undergoing dental or other minor procedures

Infective endocarditis is a relatively rare infection of the inner layer of the heart’s valves and chambers. Approximately one-third... View Article

June 2015

The immediate management of acute coronary syndromes in primary care

The majority of patients who present to general practice with chest pain are unlikely to have an acute coronary syndrome. However,... View Article

April 2015

An update on antithrombotic medicines - What does primary care need to know?

Antithrombotic medicines, such as aspirin and warfarin, have been routinely prescribed in primary care for decades for the prevention... View Article

April 2015

News Update

Brand changes for cardiovascular medicines: carvedilol, ezetimibe and ezetimibe with simvastatin View Article

April 2015

Dabigatran - An Update

This report provides an update on the use and monitoring of dabigatran between October, 2013 and September, 2014 in general practice... View Article

March 2015

The Year in Review - What did we learn in 2014?

In 2014 we published over 60 medical education articles in Best Practice Journal, spanning more than 450 pages. Context is crucial... View Article

February 2015

Managing patients who are obese: Encouraging and maintaining healthy weight-loss

The mainstays of obesity management are simple and well known to health professionals: reduce sugar and saturated fat intake,... View Article

December 2014

News Updates

Medicines update: removal of Special Authority status | Antianginal medicines: perhexiline maleate (Pexsig), nicorandil (Ikorel)... View Article

October 2014

A review of statin use and monitoring

Statins are one of the most frequently prescribed medicines in New Zealand each year. Alongside lifestyle modifications, statins... View Article

October 2014

Communicating cardiovascular risk effectively

Calculating a patient’s cardiovascular risk is relatively easy; communicating this to patients in a way that assists their decision... View Article

September 2014

News Updates

Does aspirin protect against cancer? More high-quality research is needed View Article

September 2014

Investigating myalgia in patients taking statins

Muscle pain (myalgia) and weakness is experienced by up to 10% of patients taking statins. However, myalgia is commonly experienced... View Article

August 2014

The ankle-brachial pressure index: An under-used tool in primary care?

Calculating a patient’s ankle-brachial pressure index (ABPI) is a simple, low-cost and non-invasive way of detecting peripheral... View Article

April 2014

The year that was: Key messages from Best Practice Journal 2013

2013 began with publication of the 50th issue of Best Practice Journal. In this edition we focused on the topic at the heart of... View Article

February 2014

“Oh and while you are here...”: Fasting may be unnecessary for lipid testing

A growing body of evidence and expert opinion suggests that fasting is not necessary prior to a lipid test in most scenarios.... View Article

November 2013

Hypertension in Adults: The silent killer

Hypertension is associated with a wide-range of cardiovascular and end-organ diseases. It is a frequent finding among patients... View Article

August 2013

Ticagrelor – out with the old, in with the new?

Ticagrelor (Brilinta) is a new oral antiplatelet medicine, which has been available, fully subsidised, with Special Authority,... View Article

August 2013

Giant cell arteritis: Always keep it in your head

Giant cell arteritis, also referred to as temporal arteritis, is a form of vasculitis which predominantly affects older people.... View Article

June 2013

Statins and the risk of acute kidney injury

THERE HAVE BEEN RECENT REPORTS in the literature associating the use of statins with acute kidney injury (AKI). A study by Hippisley-Cox... View Article

April 2013

Identifying patients with heart failure in primary care

Heart failure is now described as either heart failure with reduced ejection fraction (HF-REF) or heart failure with preserved... View Article

February 2013

Managing patients with heart failure in primary care

Once heart failure has been diagnosed, the goal of treatment is to improve symptoms and signs and avoid or reduce hospital admissions.... View Article

February 2013

Dabigatran revisited

Dabigatran has been available for general practitioners to prescribe since July, 2011. Dabigatran is indicated for prevention... View Article

February 2013

What your lipid test means for you

This A4 printable patient information sheet is designed to help patients understand the results of blood lipid tests and to describe... View Article

December 2012

Assessing cardiovascular risk in people with high clinical risk factors

Cardiovascular risk assessment tools automatically adjust risk to greater than 20% for people with high risk factors, e.g. a prior... View Article

September 2012

Addressing weight issues in young people and families in New Zealand

New Zealand is one of the most overweight countries in the world. The proportion of people who are overweight or obese is highest... View Article

August 2012

Looking back, looking forward: key messages 2005 – 2011

This report highlights four key prescribing and laboratory testing recommendations covered over the past five years. Over this... View Article

March 2012

Testing for CVD, diabetes and renal disease in elderly people

Consideration of laboratory testing and interpretation of subsequent results should be guided by a patients “drugs, diseases and... View Article

March 2012

PHO Performance Programme - six years on

The PHO Performance Programme was established in 2005 to improve the health of people enrolled in general practices in New Zealand... View Article

December 2011

Updated data sheet for dabigatran etexilate

The dabigatran data sheet was updated in early November 2011 to highlight the importance of an assessment of renal function in... View Article

December 2011

Transient ischaemic attack: shoot first ask questions later

A transient ischaemic attack (TIA) is a medical emergency due to the high risk that stroke will occur within the next 48 hours.... View Article

October 2011

The medical management of stable angina

This web version is a sample only, all data below the national level has been omitted. View Article

October 2011

The use of antithrombotic medicines in general practice: a consensus statement

In July 2011, a consensus forum was held in Wellington to discuss the use of antithrombotic medicines in general practice. This... View Article

October 2011

Medical management of stable angina pectoris

Patients presenting with symptoms consistent with angina is a common occurrence in general practice. Angina is formally diagnosed... View Article

October 2011

Management of atrial fibrillation in general practice

Atrial fibrillation (AF) is often an incidental finding during a routine medical assessment. The diagnosis of AF can be confirmed... View Article

October 2011

The use of dabigatran in general practice

Dabigatran (Pradaxa) is now available in New Zealand, fully funded, without Special Authority, as an alternative oral anticoagulant... View Article

September 2011

News in brief: Maternity referral guidelines & Simvastatin


• New maternity referral guidelines released
• Simvastatin: risk associated with high doses
View Article

September 2011

Rheumatic fever in Māori: what can we do better?

In New Zealand, acute rheumatic fever is now almost exclusively a disease affecting Māori and Pacific peoples. The majority of... View Article

August 2011

Raynaud's phenomenon: a whiter shade to winter's pale

Raynaud's phenomenon is a circulatory disorder, characterised by episodic attacks where arteries in the fingers and toes spasm,... View Article

August 2011

Gout: an alarm bell for diabetes and cardiovascular disease

Counties Manukau DHB Māori Gout Action Group have identified five publicly held myths about gout and presented a plan with five... View Article

August 2011

Cardiovascular disease risk assessment: what are the PHO Performance Programme indicators and how are they best achieved?

The PHO Performance Programme is a quality improvement initiative which aims to improve health and reduce disparities among people... View Article

August 2011

News in brief: Dabigatran; Antibiotics and COC; Prescription kitchen

Dabigatran to be listed | Most broad spectrum antibiotics do not affect the combined oral contraceptive | Prescription kitchen View Article

June 2011

Should I still use both CRP and ESR when investigating temporal arteritis?

CRP alone is the best test for temporal arteritis. This article is out of date. Please see updated information here: Giant... View Article

March 2011

Assessing cardiovascular risk: what the experts think

Despite much being known about cardiovascular risk assessment, there are still areas which remain contentious or are not supported... View Article

December 2010

Rheumatic fever - the neglected disease

New Zealand continues to have high rates of rheumatic fever, particularly among Pacific peoples. View Article

November 2010

Promoting healthy lifestyles for Pacific peoples

Ask a Pacific person what a healthy lifestyle means for them and the response will depend on who you are talking to. For young... View Article

November 2010

Snippets: Jadelle & Sibutramine

Jadelle – A newly funded long-acting contraceptive implant | Obesity and sibutramine: a risky combination View Article

November 2010

The warfarin dilemma

Evidence suggests that warfarin is under utilised in older people. The dilemma is that in older people with atrial fibrillation,... View Article

October 2010

Snippets: Insulin glargine & Ezetimibe

Insulin glargine – access widened from 1 August 2010 | Changes to ezetimibe (Ezetrol) and ezetimibe/simvastatin (Vytorin) pr... View Article

October 2010

Which Antihypertensive?

Once the decision has been made to initiate antihypertensive treatment, choice of medicine should be based on individual patient... View Article

October 2010

Access to clopidogrel now widened

Clopidogrel, an antiplatelet medicine, is now able to be prescribed without Special Authority approval. Clopidogrel is not recommended... View Article

October 2010

An update on statins

The decision to initiate a statin should be based upon an individual’s risk of cardiovascular disease (CVD), the likely... View Article

August 2010

HbA1c targets in people with type 2 diabetes - do they matter?

Maintaining good glycaemic control reduces the risk of microvascular complications of type 2 diabetes and may also reduce the... View Article

August 2010

Snippets: Iodine supplements Zoledronic acid & Atorvastatin


• Iodine supplements now funded
• Zoledronic acid now funded
• Atorvastatin available without Special Authority
View Article

August 2010

Medicines for weight loss - do they work

Improving diet and increasing physical activity are the main strategies for weight loss. Weight loss medicines may be considered... View Article

April 2010

Care of stroke survivors

The aim of stroke rehabilitation is for the patient to regain the best level of health, activity and participation possible within... View Article

April 2010

Best Tests March 2010

Investigating the gut & Feedback on the Troponin & Urea Testing quiz View Article

March 2010

Secondary stroke prevention

People who have had a stroke or transient ischaemic attack are at increased risk of future stroke, especially in the first few... View Article

March 2010

Time is brain: emergency treatment of stroke

Stroke is the third most common cause of death in New Zealand, with approximately 22 strokes occurring each day. Stroke should... View Article

March 2010

Upfront: Discussing weight loss in general practice

New Zealanders are getting fatter. That’s a fact. When a problem is getting worse, it is time to reassess the methods we are using... View Article

December 2009

Snippets: Aspirin for CVD & Paracetamol post-vaccination

Should aspirin still be used for primary prevention of cardiovascular desease? Reconsider paracetamol use post-vaccination View Article

December 2009

The role of troponin testing in primary care

Troponins have overtaken the traditional ‘cardiac enzymes’, and can provide valuable information of the likelihood... View Article

December 2009

Best Tests


• The role of troponin testing in Primary Care
• Should we still be measuring urea?
• QUIZ FEEDBACK: Cervical screening
View Article

December 2009

Low molecular weight heparin use in primary care

Enoxaparin (Clexane) is a low molecular weight heparin used in the treatment of acute coronary syndromes and in the treatment... View Article

November 2009

Snippets: Nicotinic acid Fosamax Plus & Genetic testing

Nicotinic acid/laropiprant (Tredaptive) ▪ Fosamax Plus ▪ Direct-to-consumer genetic testing View Article

November 2009

Making a difference in chronic kidney disease

Mate tākihi ukiuki Chronic kidney disease affects approximately 10% of the population of New Zealand, with a higher prevalence... View Article

July 2009

One Heart Many Lives

He manawa takitahi, he iwi takitini “One Heart Many Lives” is a social marketing campaign that was developed to promote... View Article

July 2009

What’s new in the 2009 New Zealand Cardiovascular Guidelines Handbook?

The New Zealand Guidelines Group recently released their updated Cardiovascular Guidelines Handbook. This article details the... View Article

June 2009

Drug monitoring - Monitoring diuretics in primary care

Monitoring a person on diuretics is necessary to assess response to treatment and to prevent adverse events, particularly electrolyte... View Article

March 2009

Warfarin vs. aspirin for the prevention of atrial fibrillation related stroke

The decision whether to choose aspirin or warfarin for stroke prevention is often not clear cut. There is evidence that treatment... View Article

February 2009

Transient ischaemic attack - a medical emergency

For one in four people, transient ischaemic attack (TIA) is a forerunner for stroke. If TIA is suspected, aspirin should be immediately... View Article

February 2009

The role of antiplatelet agents

Antiplatelet drugs including aspirin, clopidogrel and dipyrimadole, reduce the incidence of cardiovascular events by about 20-25%... View Article

February 2009

The science behind lifestyle risk factors for cardiovascular disease

When advice is provided to patients about reducing cardiovascular risk, lifestyle advice is usually discussed first. The mechanisms... View Article

December 2008

The management of anaphylaxis in primary care

Anaphylaxis is a potentially fatal hypersensitivity reaction, characterised by rapid onset of life-threatening respiratory and... View Article

December 2008

Metabolic syndrome: useful or not?

Debate about the clinical usefulness of a diagnosis of metabolic syndrome has been ongoing since it was first described. It is... View Article

December 2008

Engaging patients in managing cardiovascular risk

Once a patient understands their CVD risk, the next step is to help motivate them to make changes to reduce their risk. Lifestyle... View Article

October 2008

Communicating cardiovascular risk - getting your message across

Many GPs find it difficult to explain CVD risk to their patients. Patients who do not understand about their risk are not motivated... View Article

October 2008

Assessing cardiovascular disease risk

New PHO Performance indicators announced. GPs experiences of cardiovascular risk assessment. Finding the best approach to CVD... View Article

October 2008

Patients understanding of cholesterol

A summary of the findings of a recent study which raises questions about how much people understand about cholesterol and its... View Article

October 2008

Upfront: Cardiovascular risk screening

Professor Rod Jackson and Professor Simon Capewell debate screening of high risk individuals v population wide strategies for... View Article

October 2008

10 Minute tutorial

Creating a cardiovascular risk assessment alert in your PMS. View Article

May 2008

Cardiovascular disease and diabetes in Māori

Cardiovascular disease and type II diabetes are major causes of hospitalisations and mortality in Māori. There are many things... View Article

May 2008

Dilemmas: Managing cardiovascular risk in elderly people

Older people have a higher cardiovascular risk and therefore appear to have the most potential to benefit from risk reduction,... View Article

February 2008

Snippets: Drug information of topical interest


• Calcium Supplementation and the risk of myocardial infarction
• Use of eGFR for drug dose adjustment
• Compulsive gambling...
View Article

December 2007

Role of calcium channel blockers in hypertension

Thiazides are considered to be appropriate initial treatment for most people with hypertension. Choice of other antihypertensives,... View Article

December 2007

Laboratory Testing for Cardiovascular Risk

‘Laboratory Testing for Cardiovascular Risk’ is presented as a series of case scenarios in which a range of clinical... View Article

October 2007

Beta-blocker options following funding changes to Betaloc CR

Prescribing advice following changes to the funding of Betaloc CR View Article

September 2007

Is carvedilol superior to metoprolol in heart failure?

Carvedilol may be an option for patients initiating beta-blocker treatment for heart failure or patients in whom metoprolol is... View Article

September 2007

Upfront: co-enzyme Q10 supplements

“Would you like fries with that”. The role of co-enzyme Q10 supplements in medical treatment. View Article

September 2007

Dear Dave

Can Sumatriptan be used safely with SSRIs? Can you ever use beta-blockers in someone with a history of Asthma? View Article

August 2007

Dear Dave

What is the significance of the warning between ACE inhibitors and allopurinol. View Article

June 2007

High Blood Pressure

Recent literature has raised doubts about the role of β-blockers for lowering blood pressure and the New Zealand Guidelines... View Article

June 2007

Interactions with Warfarin

Warfarin has the potential to interact with numerous drugs resulting in significant morbidity and potentially fatal bleeds. Loss... View Article

April 2007

Opportunistic interventions in primary care can reduce stroke risk

Stroke is the third leading cause of death in New Zealand, after ischaemic heart disease and all cancers combined and is the most... View Article

April 2007

Reminder: BNP, Haemochromatosis and Vitamin D

Key recommendations for BNP, Haemochromatosis and Vitamin D testing in primary care. View Article

March 2007

Monitoring for metabolic disorders in patients taking antipsychotic drugs

This article is a brief overview of recommended monitoring for metabolic disorders and other adverse effects associated with taking... View Article

February 2007

Dear Dave

Can smoking cessation affect the dose of antipsychotics?Do statins cause nightmares?How important is it to give simvastatin at... View Article

February 2007

BNP Testing in Primary Care

from BNP/Haemochromatosis/Vitamin D: Testing in Primary CareThis resource discusses the use of BNP testing in primary care. View Article

January 2007

Amiodarone:- safety issues

Reducing adverse events in patients taking amiodarone. View Article

December 2006

Warfarin

An update on treatment of atrial fibrillation with a focus on warfarin. View Article

December 2006

Kōwhai tackles overdue INRs

INR testing plus:
• Kōwhai tackles overdue INRs
• Oral route first choice for vitamin K in excessive anticoagulation
• Re-emergence...
View Article

November 2006

Excessive anticoagulation

INR testing plus:
• Kōwhai tackles overdue INRs
• Oral route first choice for vitamin K in excessive anticoagulation
• Re-emergence...
View Article

November 2006

INR testing

INR testing plus:
• Kōwhai tackles overdue INRs
• Oral route first choice for vitamin K in excessive anticoagulation
• Re-emergence...
View Article

November 2006

INR Testing

Warfarin is the most widely used anticoagulant in New Zealand. It has a valuable role in the prevention of thrombosis but the... View Article

October 2006

Guide for using INR to manage warfarin

Appendices from "INR Testing" including:
• Guide for using INR to manage warfarin
• Treatment Guide for managing warfarin
• Drugs...
View Article

October 2006

NSAIDs and coxibs

Cardiovascular risk associated with NSAIDs and coxibsNSAIDs in the treatment of soft tissue injuries View Article

October 2006

Dear Dave

Is it safe to use beta-blockers for cardiac disease in people with COPD? View Article

October 2006

ACE Inhibitors

This POEM is focused on the use of ACE Inhibitors in diabetes, cardiovascular disorders and nephropathy. It includes information... View Article

April 2006

Best Tests: BNP

Thyroid function tests plus:
• eGFR
• BNP
• BRCA tests
View Article

December 2005

Diabetes

The diabetes POEMs focus on the drug treatment of adults with diabetes. View Article

October 2004

Ischaemic cardiovascular disease

The purpose of the PHO Performance Programme is to reduce disparities and improve health outcomes for all people using primary... View Article

June 2011