Intended for healthcare professionals


Secondary prevention of coronary heart disease in primary care is cost effective

BMJ 1996; 313 doi: (Published 31 August 1996) Cite this as: BMJ 1996;313:563
  1. Agnes Mcknight, Senior lecturer,
  2. Margaret Cupples, Senior lecturer
  1. Department of General Practice, Queen's University of Belfast, Dunluce Health Centre, Belfast BT9 7HR

    EDITOR,—Neither of two recent studies that estimated the cost of health checks in primary care was able to show cost effectiveness.1 2 It has been suggested that larger trials with longer follow up are required to assess fully the long term effectiveness and overall cost effectiveness of population cardiovascular screening. The value of primary prevention of coronary heart disease remains doubtful.

    We have reported a randomised controlled trial of health promotion for patients with angina. The intervention was shown to have a significant impact on lifestyle and survival3 and on the self assessed quality of life of people with angina cared for in general practice.4 Recently, the cost effectiveness of this personal health education, which is led by a nurse, has been investigated.5 Health services—including the prescribing of drugs; visits to the general practitioner; visits to the hospital as either an inpatient or an outpatient; and all tests, investigations, and treatments carried out—were costed, as was the cost of the health promotion visits by the nurse.

    The intervention was associated with a reduction in drug use, but no other significant difference was observed between the intervention and control groups in terms of their use of health services. The conclusion is therefore that this intervention is cost effective because it generated useful benefits at no detectable cost to health services. When benefits can be achieved without cost such services should be given top priority in the development of health services. We consider that, though debate may continue regarding the cost effectiveness of cardiovascular screening, secondary prevention of coronary heart disease in primary care should be encouraged.


    1. 1.
    2. 2.
    3. 3.
    4. 4.
    5. 5.