High BMI with Low QRISK score

Casebank Counselling
1

Where you are:
FY2 in GP surgery

Who your patient is:
Brian Andrews, 60-year old male who has come for a follow up.

Other information you have about the patient:
1 week ago he had blood test done which are as follows:
Electrocardiogram was normal
Blood tests
Haemoglobin normal
Liipids normal
Liver function test normal
Urea and electrolytes normal
Creatinine normal
Body mass index 28.5 kg/m2
Blood pressure 160/108 mmHg

What you must do
Talk to the patient and address the concerns.

QRISK is a prediction algorithm for cardiovascular disease. A QRISK score over 10 (10% risk of CVD event over the next ten years) indicates that primary prevention with lipid lowering therapy (such as statins) should be considered.

Patient information:

  • You are Brian Andrews a 60-year old man who has come for follow up.
  • You saw a TV advert which stated that it is good for old people to come and get check up.
  • You are a business man and you have got a busy lifestyle.
  • You smoke 18 cigg/day for the past 30 years
  • Your wife works as a secretary and she is busy as well and she does not have much time to cook.
  • You drink 4 glasses of wine everyday
  • You are normally fit and well and not on any medications.
  • You know that too much is not good for you, so you agree to cut down the amount of alcohol.
  • Your office is on the 14th floor so it’s not possible for you to use stairs plus you are late most of the times so using the stairs would make you even more late.
  • You do not know the normal limits of alcohol consumption-so the doctors need to tell you.
  • But you agree that drinking too much alcohol can be dangerous so you are happy to cut down. But ask the doctor-so how much should I cut down?
  • You have got no time to do exercise.

QUESTIONS:

  • How can I cut down smoking?
  • How much should I cut down my alcohol consumption?
  • If the doctor mentions that he will refer you to the smoking cessation clinic ask him/her what will the smoking cessation peple do?
  • What risk do I have?
  • Do I need to take any medications?-If the doctor offers any medications tell him/her that you are not interested in any medications at the moment.

Emotions and attitude: Normal

Set up: Chair and scenario

APPROACH

  1. GRIPS
  2. Explain the results.
  • Blood pressure is high 160/108
  • QRISK score is 9.1 (low risk)
  • Blood tests all normal
  • BMI high
  1. Take history of lifestyle and risk factors of cardiovascular disease
  • Smoking
  • Alcohol
  • Exercise
  • Diet
  • Family history of stroke, MI
  • Diabetes
  • RA
  • SLE
  • AF
  • Previous heart problems or stroke

Discuss management:

  • Blood pressure can be controlled by lifestyle changes.
  • Discuss all lifestyle changes to be done.
  • Explain that another risk score needs to be done in 5 years time.
  • Needs weight loss as BMI is 28.5.
  • Arrange a follow up in 2 months time to monitor the blood pressure
  • Refer to smoking cessation clinic
  • Offer leaflet to smoking cessation clinic
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