CLINICAL TRIALS

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

Kamlesh Khunti¹, Margaret Stone¹, Sanjoy Paul³, Jan Baines², Louise Gisborne², Azhar Farooqi¹, Xiujie Luan¹, Iain Squire²

¹ Department of Health Sciences, University of Leicester, UK
² Department of Cardiovascular Sciences, University of Leicester, UK
³ Diabetes Trial Unit, University of Oxford, UK

Dr Kamlesh Khunti, Department of Health Sciences (General Practice & PHC), University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; kk22{at}le.ac.uk

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.

Abbreviations: CHD, coronary heart disease; CHF, chronic heart failure; NNT, numbers needed to treat

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