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

Elizabeth Kathleen Delaney ^1*, Peter Murchie ¹, Amanda Lee ¹, Lewis D Ritchie ¹ and Neil C Campbell ¹

¹ University of Aberdeen, United Kingdom

^* To whom correspondence should be addressed. E-mail: edelaney{at}doctors.org.uk.

Accepted 4 December 2007

Abstract

Objectives To evaluate the effects of nurse led secondary prevention clinics for coronary heart disease 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 north east Scotland.

Participants Original study cohort of 1,343 patients (673 intervention and 670 control) under 80 years old with a working diagnosis of coronary heart disease, 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 one year

Main outcome measures Total mortality and coronary events (non-fatal myocardial infarctions and coronary deaths).

Results Mean follow-up was at 10.2 years (standard deviation, SD=0.19). There were no significant differences in total mortality or coronary events 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). Using Kaplan Meier survival analysis and adjusting for age, sex and general practice, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.17) for coronary death or non fatal myocardial infarction.<BR> There were no significant differences in the distribution cause of death classifications at either 4 years or 10 years.

Conclusions After 10 years, differences between groups were no longer significant, however total mortality survival curves for the intervention and control groups had not converged but the coronary event curves had. It may be that the earlier secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal.

Keywords: Coronary heart disease, ischaemic heart disease, nurse-led clinics, secondary prevention

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