Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial

Khunti, Kamlesh; Stone, Margaret; Paul, Sanjoy; Baines, Jan; Gisborne, Louise; Farooqi, Azhar; Luan, Xiujie; Squire, Iain
November 2007
Heart;Nov2007, Vol. 93 Issue 11, p1398
Academic Journal
Aims: To evaluate the effect of a disease management programme for patients with coronary heart disease (CHD) and chronic heart failure (CHF) in primary care. Methods: A cluster randomised controlled trial of 1316 patients with CHD and CHF from 20 primary care practices in the UK was carried out. Care in the intervention practices was delivered by specialist nurses trained in the management of patients with CHD and CHF. Usual care was delivered by the primary healthcare team in the control practices. Results: At follow up, significantly more patients with a history of myocardial infarction in the intervention group were prescribed a beta-blocker compared to the control group (adjusted OR 1.43, 95% CI 1.19 to 1.99). Significantly more patients with CHD in the intervention group had adequate management of their blood pressure (<140/85 mm Hg) (OR 1.61, 95% CI 1.22 to 2.13) and their cholesterol (<5 mmol/l) (OR 1.58, 95% CI 1.05 to 2.37) compared to those in the control group. Significantly more patients with an unconfirmed diagnosis of CHF had a diagnosis of left ventricular systolic dysfunction confirmed (OR 4.69, 95% CI 1.88 to 11.66) or excluded (OR 3.80, 95% CI 1.50 to 9.64) in the intervention group compared to the control group. There were significant improvements in some quality-of-life measures in patients with CHD in the intervention group. Conclusions: Disease management programmes can lead to improvements in the care of patients with CHD and presumed CHF in primary care.


Related Articles

  • IN BRIEF.  // Occupational Health;Oct2007, Vol. 59 Issue 10, p7 

    The article offers news briefs related to public health in Great Britain. According to a survey, conducted by health insurer HSA, six out of ten Britons are worried they may not be able to afford the cost of health in the future. A study found that screening and treating middle-aged adults with...

  • Differences in the quality of primary medical care for CVD and diabetes across the NHS: evidence from the quality and outcomes framework. McLean, Gary; Guthrie, Bruce; Sutton, Matt // BMC Health Services Research;2007, Vol. 7, p74 

    Background: Health policy in the UK has rapidly diverged since devolution in 1999. However, there is relatively little comparative data available to examine the impact of this natural experiment in the four UK countries. The Quality and Outcomes Framework of the 2004 General Medical...

  • A Pharmacoeconomic Evaluation of the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study in the United Kingdom. Buller, Nigel; Gillen, David; Casciano, Roman; Doyle, John; Wilson, Koo // PharmacoEconomics;2003 Supplement 1, Vol. 21 Issue 5, p25 

    Objective: To determine the short-term healthcare costs associated with intensive lipid lowering with atorvastatin initiated within 24-96 hours of the occurrence of acute coronary syndrome (ACS) in patients in the UK. Methods: Patient-level clinical outcome data from the Myocardial Ischaemia...

  • Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study. Saxena, Sonia; Car, Josip; Eldred, Darren; Soljak, Michael; Majeed, Azeem // BMC Health Services Research;2007, Vol. 7, p96 

    Background: Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of...

  • Quick response can reduce heart attack-related deaths.  // Graham Leader;4/19/2009, Vol. 133 Issue 71, p10 

    The article reports on the importance of immediate response in reducing and preventing heart attack-related deaths in the U.S. According to Andrew Crocker, gerontology health specialist at AgriLife Extension, immediate response to heart attack symptoms can save lives of most people experiencing...

  • NEWS IN BRIEF.  // Independent Nurse;9/7/2009, p4 

    This section offers news briefs concerning the healthcare sector. An analysis of the JUPITER trial revealed that rosuvastatin 20-milligram can minimize the risk of a heart attack or stroke by 45%. A research conducted in Australia showed the ineffectiveness and high costs of primary care...

  • Organisational interventions in primary care. Wilson, Andrew // Quality in Primary Care;2008, Vol. 16 Issue 6, p391 

    The article focuses on the main tasks of primary care including the management of chronic disease and the assessment and management of acute conditions. It cites the nurse-led secondary prevention clinics for coronary heart disease which reduce mortality and improve quality of life. Moreover,...

  • Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20 290 patients from the AMIS Plus Registry. Radovanovic, Dragana; Erne, Paul; Urban, Philip; Bertel, Osmund; Rickli, Hans; Gaspoz, Jean-Michel // Heart;Nov2007, Vol. 93 Issue 11, p1369 

    Background: Gender differences in management and outcomes have been reported in acute coronary syndrome (ACS). Objectives: To assess such gender differences in a Swiss national registry. Methods: 20 290 patients with ACS enrolled in the AMIS Plus Registry from January 1997 to March 2006 by 68...

  • Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization. Sandhoff, Brian G.; Nies, Leslie K.; Olson, Kari L.; Nash, James D.; Rasmussen, Jon R.; Merenich, John A. // American Journal of Health-System Pharmacy;1/1/2007, Vol. 64 Issue 1, p77 

    Purpose. A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between...


Read the Article


Sign out of this library

Other Topics