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LETTERS: R E Ferner and Hugh J N Bethell Secondary prevention in coronary heart disease BMJ 1998; 317: 1592 [Full text]

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Secondary prevention in coronary heart disease

R A Smith   (26 December 1998)

Lobbying primary care groups is an alternative way to fund chronic disease management clinics

H Dalal, P Evans   (5 February 1999)

Secondary prevention in coronary heart disease 26 December 1998
R A Smith Send response to journal: Re: Secondary prevention in coronary heart disease	R E Ferner points out in his letter on prevention of coronary heart diseases1 that on cost effective grounds aspirin then B blockers, and angiotensin converting enzyme inhibitors are orders of magnitude more important than statins in preventing heart disease Whilst on cost grounds this may be true if we are going to meet government targets on preventing heart disease and more importantly alleviate patient suffering we must surely use all effective interventions. The benefits from aspirin, B blockers, angiotensin converting enzyme inhibitors and statins are additive, not interchangeable. We need to use all appropriately, guided by the multiplicity of good evidence now available. The NHS can and should afford a comprehensive programme of secondary prevention of heart disease by disinvesting from unproven treatments in other disease areas. Yours sincerely Dr R A Smith 1 Ferner RE. BMJ 5th Dec 1998 Vol 317:1592
Lobbying primary care groups is an alternative way to fund chronic disease management clinics 5 February 1999
H Dalal, General Practitioners and Researchers Treliske Hospital and University of Exeter, P Evans Send response to journal: Re: Lobbying primary care groups is an alternative way to fund chronic disease management clinics	The Editor - Hugh Bethell urges general practitioners to lobby their representatives on General Practitioners Committee for coronary heart disease to be included in the payment scheme for chronic disease management1. We believe that an enormous opportunity exists with the advent of Primary Care Groups from April 1999. The recent National Service Framework document on coronary heart disease emphasises the need to provide comprehensive cardiac rehabilitation to include secondary prevention2. The Carrick Primary Care Group in Cornwall has given cardiac rehabilitation a high priority and will be encouraging all its practices to set up nurse-led coronary prevention clinics which have been shown to provide measurable health gains3. Payment for these clinics should be along the same lines as for chronic disease management clinics in asthma and diabetes which have been well established in most general practices. - page 2 - We believe that encouraging your local Primary Care Group to invest in secondary prevention is an alternative method of lobbying for funding of an improved service for patients at a local level. Previously fundholding savings have been used to provide new services in primary care. The same kind of initiatives could in future come from Primary Care Groups. Yours sincerely 1) Dr H Dalal 2) Dr Philip Evans Research Assistant in Cardiology Network Co-ordinator Treliske Hospital Somerset & N&E Devon Primary Care Truro Research Network Cornwall Institute of General Practice TR1 3LJ School of Postgraduate Medicine and and Health Sciences General Practitioner Barrack Road 18 Lemon Street EXETER EX2 5DW TRURO TR1 2LZ General Practitioner St Leonard's Medical Practice 34 Denmark Road Exeter EX1 1SF CONTACT: Tel: (01872) 252762 Fax: (01872) 252877 REFERENCES 1) Bethell HGN. Payment for chronic disease management should include coronary heart disease. BMJ 1998; 317: 1592. (5 December) 2) National Service Framework. Coronary Heart Disease "Emerging findings". London: Department of Health, 1998. 3) Campbell NC, Thain J, Deans HG, Ritchie LD, Rawles JM, Squair J. Secondary prevention clinics for coronary heart disease: randomised trial of effect of health. BMJ 1998; 316: 1434-7.