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Clinical trials
Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial
  1. Kamlesh Khunti1,
  2. Margaret Stone1,
  3. Sanjoy Paul3,
  4. Jan Baines2,
  5. Louise Gisborne2,
  6. Azhar Farooqi1,
  7. Xiujie Luan1,
  8. Iain Squire2
  1. 1
    Department of Health Sciences, University of Leicester, UK
  2. 2
    Department of Cardiovascular Sciences, University of Leicester, UK
  3. 3
    Diabetes Trial Unit, University of Oxford, UK
  1. 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

Abstract

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.

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Footnotes

  • Funding: The study was funded by the Trent NHS Executive, UK.

  • Competing interests: KK, IS and AF have received sponsorship for attending conferences and small honoraria from pharmaceutical companies that make beta-blockers, ACE inhibitors and angiotensin receptor blockers. JB and LG have received sponsorship for attending conferences from these companies.

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

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