ABSTRACT
The term cardiovascular disease (CVD) is used to include coronary artery disease (CAD), hypertension and stroke, but this chapter will focus on CAD, a disease that accounts for almost half of all cardiovascular deaths (Allender et al. 2008). The pathological processes of CAD can lead to the cardiovascular disorders known as angina, myocardial infarction (MI) (heart attack) and heart failure. In 2000 the National Service Framework for Coronary Heart Disease (CHD NSF) was published detailing 12 standards for improving prevention, diagnosis, treatment and rehabilitation (DoH 2000) (see Table 17.1). An eighth chapter was added in 2005 outlining quality requirements for the prevention of arrhythmias (abnormal heart rhythms) and sudden cardiac death (DoH 2005). In 2008 the seventh progress report on the CHD NSF highlighted the tremendous progress made including 22,000 fewer premature deaths per year (DoH 2008). Since the publication of the NSF the term coronary artery disease (CAD) has been adopted and is therefore used throughout this chapter. Given the high prevalence of CAD, carers across a variety of settings are likely to encounter individuals who have already been diagnosed or who have several risk factors increasing their susceptibility. Although hospitalisation is warranted for acute episodes, most people receiving treatment for CAD are cared for in the community. For those at high risk of CAD early recognition and referral is important so that diagnosis can be made and treatment initiated without delay. Carers also need to be aware of specific treatment regimens so that they can contribute to effective symptom control and recognise when there is deterioration. Lifestyle modification can reduce risk significantly before and following the onset of disease and knowledge of modifiable risk factors is crucial.
