Anticoagulation: Extended treatment for venous thromboembolism

Indefinite anticoagulation with direct oral anticoagulants (DOACs) is increasingly being recommended after symptomatic venous thromboembolism (VTE) in many clinical scenarios. This is because of the ease of use and lower bleeding risk of DOACs compared with warfarin and cumulative evidence of recurrence risk if anticoagulants are stopped, particularly after unprovoked VTE. The decision for extended use should be tailored to each patient, based on the risk of recurrence and bleeding, and patient preference.

Modern Medicine – Issue 2 2023

Heart Failure: A Growing Problem in Younger Patients

Heart failure (HF) is a major public health challenge, accounting for significant morbidity and premature mortality globally, including in sub-Saharan Africa (SSA). In contrast to Western countries, where HF is considered a disease of older persons, in SSA it affects younger individuals. Acute decompensated HF is the most common primary diagnosis for patients admitted to hospital with heart disease in SSA.

Modern Medicine – Issue 2 2023

Atrial Fibrillation: Management of older patients

GPs are central to the long-term primary care management of patients with atrial fibrillation (AF), noting that the target population of older people is both expanding and further rapidly ageing, rendering decision-making even more complex. A patient-centred treatment plan should focus on three key goals: detecting AF to enable early treatment initiation, managing the dysrhythmia to optimise cardiac function and prevent symptoms, and preventing thromboembolism to reduce stroke risk. An individualised, evidence-based approach to AF management requires comprehensive assessment of age-related factors to identify treatment goals, the riskbenefit profile of available treatments, and any medication management issues, with documentation of decision-making and regular reassessment to identify any changes. An integrated care approach can help GPs optimise AF management in older people, drawing on the collective expertise and support of the wider healthcare team, particularly as both risk assessments and treatment goals change with increasing age.

Modern Medicine – Issue 1 2023