Managing established coronary heart disease

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7127.309 (Published 24 January 1998) Cite this as: BMJ 1998;316:309

Coronary heart disease should be recognised as chronic progressive condition

  1. Hugh Bethell, Chairman, secondary prevention committeea
  1. a Coronary Prevention Group, London School of Hygiene, Department of Public Health and Policy, London WC1E 7DB
  2. b Department of General Practice and Primary Care, St Bartholomew's and the Royal London School of Medicine and Dentistry, London E1 4NS

    Editor—As Moher et al say, general practice is indeed “ideally placed to provide coordinated preventive care” for established coronary heart disease.1 Sadly, evidence suggests that it often fails to do so.2 3 One reason may be that coronary disease is not fully recognised as a chronic progressive condition needing regular follow up. Unlike with two other common chronic diseases, asthma4 and diabetes mellitus,5 there are no agreed national guidelines for the follow up of coronary disease in general practice.

    When the health promotion clinics of the “Clarke contract” were replaced by the banding system in 1993, asthma and diabetes were recognised as chronic diseases meriting separate payment for their surveillance. The long term care of coronary disease, together with hypertension and cerebrovascular disease, was hidden in band 2 alongside such dubious activities …

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