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Q J Med 1999; 92: 245-250
© 1999 Association of Physicians

Secondary prevention of coronary heart disease in primary care: a healthy heart initiative

D.E.H. Flanagan, P. Cox, D. Paine1, J. Davies and M. Armitage

From the Bournemouth Diabetes and Endocrine Centre, and 1 Department of Audit and Clinical Effectiveness, Royal Bournemouth Hospital, Bournemouth, UK

Received 23 November 1998 and in revised form 5 March 1999

Dr M. Armitage, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset BH7 7DW

We assessed the effectiveness of secondary prevention of coronary heart disease (CHD) in primary care, in a cross-sectional study of 1015 patients aged <75 years with documented CHD. Patients records were examined for documentation of CHD risk factors; 722 patients then attended education sessions where blood pressure and cholesterol were measured, a supervised questionnaire detailing modifiable risk factors was completed, and advice on lifestyle modification was given. Management of risk factors was generally poor, and was worse in women. Approximately 20% of subjects remained hypertensive, with half of these receiving anti-hypertensive medication. Examining the primary care records, serum cholesterol was documented in 17.5% of men and 26.5% of women. Of the 722 subjects who had cholesterol measured, 30% of men and 25% of women had cholesterol <5.2 mmol/l. Mean cholesterol was significantly higher in the women (6.1 mmol/l vs. 5.6 mmol/l, p=0.001). Lifestyle risk management was also poor, with significant numbers smoking and drinking more than recommended. Women were more overweight than men (mean BMI 27.9 kg/m2 vs. 26.9 kg/m2, p=0.006). Aspirin was being taken by 56% of patients.


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