Secondary prevention clinics for coronary heart disease: randomised trial of effect on health

BMJ 1998;316:1434-1437 ( 9 May )

General Practice

Secondary prevention clinics for coronary heart disease: randomised trial of effect on health

Editorialby van der Weijden and Grol and p 1430

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

^a Department of General Practice and Primary Care, Foresterhill Health Centre, Aberdeen AB25 2AY, ^b Denburn Health Centre, Aberdeen AB25 1QB, ^c Medicines Assessment Research Unit, Medical School, Foresterhill, Aberdeen AB25 2ZD, ^d Department of Public Health, Medical School, Foresterhill, Aberdeen AB25 2ZD

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

Objective: To evaluate the effects of secondary prevention clinics run by nurses in general practice on the healthof patients with coronary heart disease.
Design: Randomised controlled trial of clinics over one year with assessment by self completed postal questionnairesand audit of medical records at the start and end of the trial.
Setting: Random sample of 19 general practices in northeast Scotland.
Subjects: 1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease whodid not have terminal illness or dementia and were not housebound.
Intervention: Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular followup.
Main outcome measures: Health status measured by the SF-36 questionnaire, chest pain by the angina type specification,and anxiety and depression by the hospital anxiety and depressionscale. Use of health services before and during the study.
Results: There were significant improvements in six of eight health status domains (all functioning scales, pain, andgeneral health) among patients attending the clinic. Role limitationsattributed to physical problems improved most (adjusted difference8.52, 95% confidence interval 4.16 to 12.9). Fewer patients reportedworsening chest pain (odds ratio 0.59, 95% confidence interval0.37 to 0.94). There were no significant effects on anxiety ordepression. Fewer intervention group patients required hospitaladmissions (0.64, 0.48 to 0.86), but general practitioner consultationrates did not alter.
Conclusions: Within their first year secondary prevention clinics improved patients' health and reduced hospital admissions.

Key messages

Nurse led clinics in general practice were used to promote secondary prevention to patients with coronary heart disease
Within the first year the health of patients invited to the clinics improved
Most benefit was in functional status, but chest pain improved too
There was no effects on anxiety or depression
There were significant reductions in hospital admissions in the first year

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