Heart 1998;80:447-452 ( November )

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

N C Campbell,^a L D Ritchie,^a J Thain,^b H G Deans,^a J M Rawles,^c J L Squair^d

^a Department of General Practice and Primary Care, Foresterhill Health Centre, Aberdeen, UK, ^b Denburn Health Centre, Rosemount Viaduct, Aberdeen, UK, ^c Medicines Assessment Research Unit, Medical School, Foresterhill, Aberdeen, UK, ^d Department of Public Health, Medical School, Foresterhill, Aberdeen, UK

Correspondence to: Dr N C Campbell, Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK.

Accepted for publication 16 June 1998

ObjectiveTo evaluate whether nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease.
DesignRandomised controlled trial.
SettingA random sample of 19 general practices in northeast Scotland.
Patients1173 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.
InterventionNurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up.
Main outcome measuresComponents 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.
ResultsThere 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.
ConclusionsNurse 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.

Keywords: coronary heart disease;  secondary prevention;  randomised controlled trial;  nurse led clinics

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© 1998 by Heart
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