Preventing recurrent coronary heart disease

We need to attend more to implementing evidence based practice

General practice pp 1430, 1434

Following the publication of several recent large studies (4S, CARE, and WOSCOPS), there is little doubt about the importance of prevention in patients with coronary heart disease, though controversy still exists about its value in patients without symptoms. General practitioners are in a favourable position to take on the task of secondary prevention, since most have a continuing relationship with their patients, and these patient contacts offer opportunities for measuring cardiovascular risk factors. Nevertheless, preventive care in general practice is haphazard, 1 2 and in this issue Campbell et al confirm this shortfall (p 1430).3 The question that therefore arises is how to implement the new evidence on preventing coronary heart disease effectively in general practice.

An audit in 95 practices in the Netherlands showed that many general practitioners had a critical attitude towards integrating prevention into practice4 and that few practices were sufficiently well organised to provide effective …