BMJ 1999;318:706-711 ( 13 March )

General Practice

Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP)

Kate Jolly, senior registrar, a Fiona Bradley, research fellow, a Stephen Sharp, lecturer, b Helen Smith, senior lecturer, a Simon Thompson, professor, c Ann-Louise Kinmonth, professor, d David Mant, professor, a for the SHIP Collaborative Group.

a Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, b Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, c Department of Medical Statistics and Evaluation, Imperial College School of Medicine, Hammersmith Hospital, London W12 0NN, d General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Cambridge CB2 2SR

Correspondence to: Professor D Mant, Department of Primary Health Care, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF

Objective: To assess the effectiveness of a programme to coordinate and support follow up care in general practice after a hospital diagnosis of myocardial infarction or angina.
Design: Randomised controlled trial; stratified random allocation of practices to intervention and control groups.
Setting: All 67 practices in Southampton and south west Hampshire, England.
Subjects: 597 adult patients (422 with myocardial infarction and 175 with a new diagnosis of angina) who were recruited during hospital admission or attendance at a chest pain clinic between April 1995 and September 1996.
Intervention: Programme to coordinate preventive care led by specialist liaison nurses which sought to improve communication between hospital and general practice and to encourage general practice nurses to provide structured follow up.
Main outcome measures: Serum total cholesterol concentration, blood pressure, distance walked in 6 minutes, confirmed smoking cessation, and body mass index measured at 1 year follow up.
Results: Of 559 surviving patients at 1 year, 502 (90%) were followed up. There was no significant difference between the intervention and control groups in smoking (cotinine validated quit rate 19% v 20%), lipid concentrations (serum total cholesterol 5.80 v 5.93 mmol/l), blood pressure (diastolic pressure 84 v 85 mm Hg), or fitness (distance walked in 6 minutes 443 v 433 m). Body mass index was slightly lower in the intervention group (27.4 v 28.2; P=0.08).
Conclusions: Although the programme was effective in promoting follow up in general practice, it did not improve health outcome. Simply coordinating and supporting existing NHS care is insufficient. Ischaemic heart disease is a chronic condition which requires the same systematic approach to secondary prevention applied in other chronic conditions such as diabetes mellitus.


Key messages

  • This trial assessed an intervention to coordinate preventive care in general practice of patients with newly diagnosed ischaemic heart disease

  • Though the programme of intervention was effective in promoting follow up in general practice and rehabilitation, it did not improve objective measures of risk

  • The emphasis of the educational programme for nurses in general practice and rehabilitation, which highlighted the importance of motivating behaviour change and the likelihood of full recovery after myocardial infarction, was at odds with patients' experiences

  • Simply coordinating and supporting existing NHS care seems insufficient

  • Angina and myocardial infarction merit the same systematic approach to secondary prevention as that given to other chronic diseases such as diabetes




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Rapid Responses:

Read all Rapid Responses

TIME TO CHANGE DIRECTIONS IN CARDIO CARE
Eddie Vos
bmj.com, 12 Mar 1999 [Full text]
Formalising care will not help
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bmj.com, 23 Mar 1999 [Full text]
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