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Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP)

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7185.706 (Published 13 March 1999) Cite this as: BMJ 1999;318:706
  1. Kate Jolly, senior registrara,
  2. Fiona Bradley, research fellowa,
  3. Stephen Sharp, lecturerb,
  4. Helen Smith, senior lecturera,
  5. Simon Thompson, professorc,
  6. Ann-Louise Kinmonth, professord,
  7. David Mant, professor for the SHIP Collaborative Groupa
  1. a Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST
  2. b Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. c Department of Medical Statistics and Evaluation, Imperial College School of Medicine, Hammersmith Hospital, London W12 0NN
  4. d General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Cambridge CB2 2SR
  1. Correspondence to: Professor D Mant, Department of Primary Health Care, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF
  • Accepted 4 December 1998

Abstract

Objective: To assess the effectiveness of a programme to coordinate and support follow up care in general practice after a hospital diagnosis of myocardial infarction or angina.

Design: Randomised controlled trial; stratified random allocation of practices to intervention and control groups.

Setting: All 67 practices in Southampton and south west Hampshire, England.

Subjects: 597 adult patients (422 with myocardial infarction and 175 with a new diagnosis of angina) who were recruited during hospital admission or attendance at a chest pain clinic between April 1995 and September 1996.

Intervention: Programme to coordinate preventive care led by specialist liaison nurses which sought to improve communication between hospital and general practice and to encourage general practice nurses to provide structured follow up.

Main outcome measures: Serum total cholesterol concentration, blood pressure, distance walked in 6 minutes, confirmed smoking cessation, and body mass index measured at 1 year follow up.

Results: Of 559 surviving patients at 1 year, 502 (90%) were followed up. There was no significant difference between the intervention and control groups in smoking (cotinine validated quit rate 19% v 20%), lipid concentrations (serum total cholesterol 5.80 v 5.93 mmol/l), blood pressure (diastolic pressure 84 v 85 mm Hg), or fitness (distance walked in 6 minutes 443 v 433 m). Body mass index was slightly lower in the intervention group (27.4 v 28.2; P=0.08).

Conclusions: Although the programme was effective in promoting follow up in general practice, it did not improve health outcome. Simply coordinating and supporting existing NHS care is insufficient. Ischaemic heart disease is a chronic condition which requires the same systematic approach to secondary prevention applied in other chronic conditions such as diabetes mellitus.

Footnotes

  • Contributors K Done, K Enright, and L Wright were the liaison nurses who led the intervention. DM, A-LK, SS, ST, David Wood, Martin Buxton, Viv Speller, Marie Johnston, Derek Johnston, and Derek Waller all contributed to the study design. A-LK, Mildred Blaxter, Madeline Gantley, Angela Spackman, and Rose Wiles designed the qualitative study. Fiona Bradley was the first medical coordinator (responsible for day to day management of the trial) and put the initial protocol into operation; KJ took over this role in March 1966. DM oversaw the trial as principal investigator; HS deputised in this role for much of 1997–8. ST and SS designed and carried out the statistical analysis. Andrew Davies and Martin Buxton designed and carried out the economic analysis. Derek Johnston and Marie Johnston designed the psychological assessment. Viv Speller was responsible for designing behavioural change aspects of the intervention and for organising initial nurse training and support. Derek Waller coordinated the hospital based element of the intervention. David Wood chaired the steering group. KJ and DM drafted the text of the paper with the support of a writing group consisting of the other authors listed. DM is guarantor for the study.

    Editorial by Hobbs and Murray

    Members of the SHIP Collaborative group are listed at the end of the paper

  • Funding The study was funded by a research and development national programme grant from the NHS Executive, with service support from Southampton and South West Hampshire Health Authority. Rose Wiles was in receipt of a NHS South and West Region research and development research training fellowship.

  • Competing interests None declared.

  • Accepted 4 December 1998
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