Secondary prevention clinics for coronary heart disease: a 10-year follow-up of a randomised controlled trial in primary care

Delaney, E. K.; Murchie, P.; Lee, A. J.; Ritchie, L. D.; Campbell, N. C.
November 2008
Heart;Nov2008, Vol. 94 Issue 11, p1419
Academic Journal
Objectives: To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease (CHD) in primary care on total mortality and coronary event rates after 10 years. Design: Follow-up of a randomised controlled trial by review of national datasets. Setting: Stratified random sample of 19 general practices in northeast Scotland. Participants: Original study cohort of 1343 patients, aged <80 years, with a working diagnosis of CHD, but without dementia or terminal illness and not housebound. Intervention: Nurse-led secondary prevention clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow-up for 1 year, Main outcome measures: Total mortality and coronary events (non-fatal myocardial infarctions (MIs) and coronary deaths). Results: Mean (SD) follow-up was at 10.2 (0.19) years. No significant differences in total mortality or coronary events were found at 10 years. 254 patients in the intervention group and 277 patients in the control group had died: cumulative death rates were 38% and 41%, respectively (p = 0.177). 196 coronary events occurred in the intervention group and 195 in the control group: cumulative event rates were 29.1% and 29.1%, respectively (p = 0.994). When Kaplan-Meier survival analysis, adjusted for age, sex and general practice, was used, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.18) for coronary death or non-fatal Ml. No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years. Conclusions: After 10 years, differences between groups were no longer significant. Total mortality survival curves for the intervention and control groups had not converged, but the coronary event survival curves had. Possibly, therefore, the earlier that secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal.


Related Articles

  • An audit of secondary prevention of coronary heart disease in post acute myocardial infarction patients in primary care. Dunkley, Alison; Stone, Margaret; Squire, Iain; Johnson, Tracy; Farooqi, Azhar; Khunti, Kamlesh // Quality in Primary Care;2006, Vol. 14 Issue 1, p15 

    Introduction The National Service Framework for Coronary Heart Disease (CHD) defines national standards for delivering care after acute myocardial infarction (AMI). Objectives To improve appropriate use of secondary prevention measures and investigations after an AMI at the interface of primary...

  • Modular prevention of heart disease following acute coronary syndrome (ACS) [ISRCTN42984084]. Redfern, Julie; Ellis, Elizabeth; Briffa, Tom; Freedman, SB // BMC Cardiovascular Disorders;2006, Vol. 6, p26 

    Background: Coronary heart disease (CHD) is a major cause of morbidity and mortality in Australia and it is recommended that all persons with unstable angina (UA) or myocardial infarction (MI) participate in secondary prevention as offered in cardiac rehabilitation (CR) programs. However, the...

  • Strategies for reducing coronary risk factors in primary care: Which is most cost effective? Field, K.; Thorogood, M. // BMJ: British Medical Journal (International Edition);4/29/95, Vol. 310 Issue 6987, p1109 

    Examines the relative cost-effectiveness of a range of screening and intervention strategies for preventing coronary heart disease in primary care. Minimal screening of blood pressure and personal history of vascular disease as the most cost-effective strategy; Estimated costs of all...

  • Current strategies for the primary prevention of CAD. Pinkowish, Mary Desmond // Patient Care;11/30/1998, Vol. 32 Issue 19, p19 

    Discusses issues concerning the primary prevention of coronary artery disease (CAD). Population-based public health initiatives; Active identification and treatment of high-risk individuals; West of Scotland Study; Assessment of risk of coronary heart disease (CHD) in men and women;...

  • The Dundee coronary risk-disk for management of change in risk factors. Tunstall-Pedoe, Hugh // BMJ: British Medical Journal (International Edition);9/28/91, Vol. 303 Issue 6805, p744 

    Examines the efficacy of Dundee coronary risk-disk for grading and monitoring modifiable coronary risk in primary care in Great Britain. Reasons for the need of valid scoring system for coronary risk; Improvement of effectiveness of high risk approach to coronary prevention; Description of the...

  • An action plan for preventing coronary heart disease in primary care. Rose, Geoffrey; Fowler, Godfrey; Haines, Andrew; Jacobson, Bobbie; Julian, Desmond; O'Connor, Michael; Rayner, Mike; Schofield, Theo; Shepherd, Jim; Spiegal, Nicki; Tunstall-Pedoe, Hugh; Welsh, Joan // BMJ: British Medical Journal (International Edition);9/28/91, Vol. 303 Issue 6805, p748 

    Provides the action plan for preventing coronary heart disease in primary care in Great Britain. Groups allocated to patients from the proposed practices; Decisions necessary in the carrying out the action plan; Utilization of the action plan to any level of testing.

  • Five year prognosis in patients with angina identified in primary care: incident cohort study. Buckley, Brian S.; Simpson, Colin R.; McLernon, David J.; Murphy, Andrew W.; Hannaford, Philip C. // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;8/22/2009, Vol. 339 Issue 7718, p438 

    Objective To ascertain the risk of acute myocardial infarction, invasive cardiac procedures, and mortality among patients with newly diagnosed angina over five years. Design Incident cohort study of patients with primary care data linked to secondary care and mortality data. Setting 40 primary...

  • More Intensive Glycemic Control Reduces Nonfatal Myocardial Infarction But Not All-Cause Mortality. Pignone, Michael // Clinical Diabetes;Spring2010, Vol. 28 Issue 2, p87 

    In this article, the author discusses a study related to role of glycemic control in myocardial infarction and deaths related to it, conducted by K.K. Ray and colleagues. The author is critical of the evidences used for reduction of cardiovascular attacks with controlled glycemic. He states that...

  • Analysing the Large Decline in Coronary Heart Disease Mortality in the Icelandic Population Aged 25-74 between the Years 1981 and 2006. Aspelund, Thor; Gudnason, Vilmundur; Magnusdottir, Bergrun Tinna; Andersen, Karl; Sigurdsson, Gunnar; Thorsson, Bolli; Steingrimsdottir, Laufey; Critchley, Julia; Bennett, Kathleen; O'Flaherty, Martin; Capewell, Simon // PLoS ONE;2010, Vol. 5 Issue 11, p1 

    Background: Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s. We examined how much of the decrease between 1981 and 2006 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. Methodology: The...


Read the Article


Sign out of this library

Other Topics