We are delighted to announce that we have two new members of the PCCS Committee: Dr Paul Ferenc GP and GPSI in Cardiology. Graduated from Birmingham and completed foundation years in the North West, where he undertook a cardiology house job until moving to Worcestershire to undertake GP training. Since 2015 Dr Ferenc has been working at the local hospital as a GPwSI in cardiology with the local cardiology team.

The PCCS 2nd Annual Conference ‘Cardiovascular Guidelines into Practice’ took place on Thursday 16th May at the Hallam Conference Centre in Central London. A 70 strong multidisciplinary attendance of GPs, nurses, pharmacists and other health care professionals involved in cardiovascular disease care from across the UK were treated to a day of high quality and entertaining education.

The meeting was opened by our President Professor Ahmet Fuat who outlined the program, reiterated the aims of the PCCS and informed us of PCCS Board changes to take place formally at our AGM at the PCCJ meeting in Nottingham in November. Professor Ahmet Fuat, Dr Kathryn Griffith (Secretary) and Professor Michael Norton (Treasurer) will stand down to allow President-Elect Dr Jim Moore, Secretary-Elect Helen Williams and Treasurer-Elect Dr Richard Blakey to take over. Professor Fuat with stay on as immediate Past President, Professor Norton as an observer member
with a remit in Resuscitation Medicine and Dr Griffith will stand down completely. Two new board members will be elected and announced soon. Prof Fuat extended a deep debt of gratitude to both colleagues and in particular Kathryn who has put so much into the Society over many years. Thank you Kathryn.

The meeting was opened by Dr Matt Kearney NHSE National Clinical Director for CVD Prevention. His main message was that primary care needs to work differently using pharmacists, nurses and others to increase detection and management of hypertension, atrial fibrillation, lipids, familial hypercholesterolaemia and heart failure. This he said was imperative to address the recent National picture of a slowing down of CVD mortality and morbidity and close the detection and treatment gap in the priority areas outlined above. He felt the PCCS were central to CVD Leadership and implementation
of the proposed CVD Prevention Program and emerging Primary Care Networks
(PCNs) which will be expected to deliver to drive up CVD care standards.

There followed six sessions addressing diagnosis and management of patients presenting with common primary care symptoms and signs including palpitations, breathlessness, raised blood pressure, coronary artery disease with residual CV risk, diabetic patient with high CVD risk and a patient with a raised cholesterol. Real life case studies were outlined by session chairs, followed by presentations on diagnostic work up, guidelines and practical examples from around the country of how guidelines had been put into practice. All sessions were expertly presented and generated considerable
debate amongst our lively and interactive audience.

We would like to thank all of the speakers that contributed to the day and in particular the following:

Primary Care Cardiovascular Journal
British Society for Heart Failure
The British and Irish Hypertension Society
The British Cardiac Society
The Primary Care Diabetes Society
British Heart Foundation
AHSN North East

Finally we wouldn’t have been able to run such a fantastic day if it hadn’t been for our industry sponsors

Bayer
Novartis
Amgen
Medtronic
Sanofi

Please watch this space for further opportunities to download the slides.

Bev Bostock RGN MSc MA Queen’s Nurse

Nurse Practitioner Mann Cottage Surgery Gloucestershire

PCCS nurse board member

Renal impairment, including end stage renal disease is a major concern in the management of diabetes and has a significant impact on patients, their families and resources1,2.  It is estimated that the need for dialysis (which is very costly, has a negative impact on quality of life and has a poor prognosis) is set to rise from 3 million to 5 million people worldwide by 2035, especially with the increasing prevalence of diabetes3.  The CREDENCE study, which was stopped early based on a planned interim analysis and on the recommendation of the safety committee, showed that using 100mg of canagliflozin, an SGLT2 inhibitor, reduced the risk of end-stage kidney disease or death from renal or cardiovascular causes by 30% when compared with placebo4.  Canagliflozin, in line with other SGLT2 inhibitors, also has a very positive effect on cardiovascular disease and heart failure, something that had already been highlighted in previous cardiovascular outcomes studies5,6,7.  Importantly, there was also a strong safety signal, with no increase in amputations or fracture in the treated group.  This is the first study to confirm that an SGLT2 inhibitor (specifically canagliflozin 100mg) on top of the maximum tolerated dose of ACE inhibitor or ARB can have a positive impact on renal impairment.  

It remains to be seen how quickly a licence change will follow as currently SGLT2 inhibitors can only be initiated in people with an eGFR >60ml/min, although they can be continued if the eGFR drops after this, up to 45ml/min, at which point they should be stopped.  The data from CREDENCE begs consideration of off licence prescribing in the meantime.

Excerpt from study:

4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). 

1 Jha V et al (2018) Ethical issues in dialysis therapy. Lancet, 389 (10081) p1851-56

2 Dąbrowska-Bender M et al (2018). The impact on quality of life of dialysis patients with renal insufficiency. Patient preference and adherence, 12, 577–583

3 Lyanage T et al (2015) Worldwide access to treatment for end-stage kidney disease Lancet 385:1975-82

4 Perkovic V et al (2019) Canagliflozin and Renal Outcomes in Type 2 diabetes and Nephropathy NEJM

5 Neal B et al (2017) Canagliflozin and cardiovascular and renal events in type 2 diabetes NEJM 337:644-57

6 Zinman B et al (2015) Empagliflozin cardiovascular outcomes and mortality in type 2 diabetes NEJM 373:2117-28

7 Wiviott SD et al (2019) Dapagliflozin cardiovascular outcomes in type 2 diabetes NEJM 380:347-57

Congratulations to Professor Ahmet Fuat, President of the PCCS, for being elected as a Fellow of the Royal College of Physicians of Edinburgh. Professor Fuat said “he is honoured and humbled”

Professor Fuat has been in general practice in Darlington since 1986, having graduated from Aberdeen University. He is a Fellow of the RCGP and RCP London. As well as being a North East and North Cumbria GP Research Engagement Lead and CCG Cardiology Lead, he also works as a GP specialist in Cardiology and for 16 years has run an integrated heart failure service across primary and secondary care in Darlington. Holding a PhD from Durham University he is an active researcher in cardiology and was holds an honorary chair in Primary Care Cardiology from Durham University School of Health, Medicine and Pharmacy. Professor Fuat sits on the editorial boards of both the BJC and PCCJ and is an active member of the BCS and the BSH. He has published widely in peer reviewed journals. He is a tutor on the Bradford postgraduate diploma in cardiology course and chairs and lectures in cardiology nationally and internationally. He has served on the NICE and ESC guideline development groups on heart failure (acute and chronic) and myocardial infarction respectively.