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Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial
  1. Kamlesh Khunti (kk22{at}le.ac.uk)
  1. University of Leicester, United Kingdom
    1. Margaret Stone (mas20{at}le.ac.uk)
    1. University of Leicester, United Kingdom
      1. Sanjoy Paul (sanjoy.paul{at}dtu.ox.ac.uk)
      1. University of Oxford, United Kingdom
        1. Jan Baines (janet.baines{at}uhl-tr.nhs.uk)
        1. University of Leicester, United Kingdom
          1. Louise Gisbourne (louise.gisborne{at}uhl-tr.nhs.uk)
          1. University of Leicester, United Kingdom
            1. Azhar Farooqi (farooqi_am{at}gp-c82063.nhs.uk)
            1. University of Leicester, United Kingdom
              1. Xiujie Luan
              1. University of Leicester, United Kingdom
                1. Iain Squire (is11{at}le.ac.uk)
                1. University of Leicester, United Kingdom

                  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 We carried out a cluster randomised controlled trial of 1316 patients with CHD and CHF from 20 primary care practices in the UK. 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 health care 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 odds ratio 1.43, 95% CI 1.19-1.99). Significantly more patients with CHD in the intervention group had adequate management of their blood pressure (<140/85 mmHg) (OR 1.61, 95% CI 1.22-2.13) and their cholesterol (<5mmol/l) (OR 1.58, 95% CI 1.05-2.37) 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 1.88-11.66) or excluded (OR 3.80, 95% CI 1.50-9.64) 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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