Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care

• Published in: Heart (British Cardiac Society) Vol. 80; no. 5; pp. 447 - 452
• Main Authors: Campbell, N C, Ritchie, L D, Thain, J, Deans, H G, Rawles, J M, Squair, J L
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.11.1998; BMJ; BMJ Publishing Group LTD
• Subjects: Aged; Ambulatory Care Facilities - organization & administration; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Coronary Disease - blood; Coronary Disease - nursing; Coronary Disease - prevention & control; Coronary heart disease; Dietary Fats - administration & dosage; Female; Heart; Humans; Hypertension - drug therapy; Lipids; Lipids - blood; Male; Medical sciences; Middle Aged; Nurse Clinicians; nurse led clinics; Odds Ratio; Patient Compliance; Patient Education as Topic; Primary care; randomised controlled trial; secondary prevention; Smoking Cessation; Studies; United Kingdom; Scotland; Great Britain; Europe; Physical exercise; Human; Tobacco smoking; Cardiovascular disease; Exploration; Coronary heart disease; Drug compliance; Prevention; Treatment; Diet; Surveillance; Risk factor; Ambulatory; Public health; Nurse
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.80.5.447

Objective To evaluate whether nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease. Design Randomised controlled trial. Setting A random sample of 19 general practices in northeast Scotland. Patients 1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease, but without terminal illness or dementia and not housebound. Intervention Nurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up. Main outcome measures Components of secondary prevention assessed at baseline and one year were: aspirin use; blood pressure management; lipid management; physical activity; dietary fat; and smoking status. A cumulative score was generated by counting the number of appropriate components of secondary prevention for each patient. Results There were significant improvements in aspirin management (odds ratio 3.22, 95% confidence interval 2.15 to 4.80), blood pressure management (5.32, 3.01 to 9.41), lipid management (3.19, 2.39 to 4.26), physical activity (1.67, 1.23 to 2.26) and diet (1.47, 1.10 to 1.96). There was no effect on smoking cessation (0.78, 0.47 to 1.28). Of six possible components of secondary prevention, the baseline mean was 3.27. The adjusted mean improvement attributable to intervention was 0.55 of a component (0.44 to 0.67). Improvement was found regardless of practice baseline performance. Conclusions Nurse run clinics proved practical to implement in general practice and effectively increased secondary prevention in coronary heart disease. Most patients gained at least one effective component of secondary prevention and, for them, future cardiovascular events and mortality could be reduced by up to a third.