Secondary prevention of heart disease needs to be systematic

Two trials in the BMJ have shown that nurse led intervention in general practice in the United Kingdom may help prevent recurrent myocardial infarction. Both trials based this assessment on outcomes reported by patients. On p 706 Jolly et al report the final results of the Southampton heart integrated care project (SHIP), a randomised trial of the effect of a secondary preventive programme applied across a health district on objective measures of cardiac risk. The programme did promote follow up in general practice, but it did not improve health outcome. The authors conclude that secondary prevention of ischaemic heart disease requires the same systematic approach as other chronic conditions such as diabetes. In a second study (p 711) the authors used qualitative approaches to refine and understand complex interventions such as that used in the SHIP trial. One insight was that patients perceived a heart attack as an acute event with little implications for lifestyle changes.


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