Secondary prevention in coronary heart disease: baseline survey of provision in general practice

BMJ 1998;316:1430-1434 ( 9 May )

General Practice

Secondary prevention in coronary heart disease: baseline survey of provision in general practice

Editorialby van der Weijden and Grol and p 1434

Neil C Campbell, clinical research fellow, ^a Joan Thain, health visitor, ^b H George Deans, lecturer in clinical psychology, ^a Lewis D Ritchie, Mackenzie professor of general practice, ^a John M Rawles, honorary senior lecturer. ^c

^a Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, ^b Grampian Healthcare, Denburn Health Centre, Aberdeen AB25 1QB, ^c Medicines Assessment Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD

Correspondence to: Dr Campbell n.campbell{at}abdn.ac.uk

Objective: To determine secondary preventive treatment and habits among patients with coronary heart disease in generalpractice.
Design: Process of care data on a random sample of patients were collected from medical records. Health and lifestyledata were collected by postal questionnaire (response rate 71%).
Setting: Stratified, random sample of general practices in Grampian.
Subjects: 1921 patients aged under 80 years with coronary heart disease identified from pre-existing registers of coronaryheart disease and nitrate prescriptions.
Main outcome measures: Treatment with aspirin, $beta$ blockers, and angiotensin converting enzyme inhibitors. Managementof lipid concentrations and hypertension according to local guidelines.Dietary habits (dietary instrument for nutritional evaluationscore), physical activity (health practice indices), smoking,and body mass index.
Results: 825/1319 (63%) patients took aspirin. Of 414 patients with recent myocardial infarction, 131 (32%) took $beta$ blockers, and of 257 with heart failure, 102 (40%) took angiotensinconverting enzyme inhibitors. Blood pressure was managed accordingto current guidelines for 1566 (82%) patients but lipid concentrationsfor only 133 (17%). 673 of 1327 patients (51%) took little orno exercise, 245 of 1333 (18%) were current smokers, 808 of 1264(64%) were overweight, and 627 of 1213 (52%) ate more fat thanrecommended.
Conclusion: In terms of secondary prevention, half of patients had at least two aspects of their medical managementthat were suboptimal and nearly two thirds had at least two aspectsof their health behaviour that would benefit from change. Thereseems to be considerable potential to increase secondary preventionof coronary heart disease in general practice.

Key messages

Patients with coronary heart disease can benefit from both medical and lifestyle secondary prevention measures
This study found that half of patients with coronary heart disease in general practice had at least two missed opportunities for effective medical interventions
Nearly two thirds of patients with coronary heart disease in general practice had two or more high risk lifestyle factors that would benefit from change
There seems to be plenty of opportunity for improving secondary prevention of coronary heart disease in general practice

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