Author’s reply to Valentine, Ninan, and Dalal and colleaguesBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6357 (Published 25 November 2015) Cite this as: BMJ 2015;351:h6357
- Adam Timmis, professor of clinical cardiology1
- 1National Institute for Health Research Biomedical Research Unit, Barts Heart Centre, London EC1A 7BE, UK
Valentine reminds us that heart disease has implications for activities such as driving.1 2 Clearly these will vary by country, but in the UK the government document he cites lays out the national rules and should be read by all who treat patients with acute coronary syndromes.
Ninan thinks that the treatment preferences of elderly frail patients with acute coronary syndromes may differ from those of more robust patients.3 He is careful to rule against denying such patients high quality treatment but is, I am sure, correct when he recommends that care should be patient centred. Certainly, prolonging the process of dying should play no part in our approach to treating acute coronary syndromes.
Dalal and colleagues emphasise the importance of aftercare in patients after acute coronary syndromes.4 If I gave the impression of “guarded endorsement” of rehabilitation courses it is only because such courses are difficult to the evaluate, and although they seems to have a positive effect on quality of life, convincing evidence of direct survival benefit is unavailable. Nevertheless, I agree with the main thrust of their response, that rehabilitation courses and primary care physicians play a vital role in secondary prevention through lifestyle education and prescription of evidence based treatments.
Cite this as: BMJ 2015;351:h6357
Competing interests: None declared.