Coronary heart disease (CHD) remains a major cause of morbidity and mortality in the UK. Following a myocardial infarction (MI) the risk of disease progression is high. Modification of vascular risk factors in such patients—secondary prevention—is particularly effective with evidence supporting use of antiplatelet agents, oral anticoagulants, β blockers, angiotensin converting enzyme (ACE) inhibitors, statins, and smoking cessation. Good diabetic control and provision of cardiac rehabilitation are also important.

The aim of this study was to assess the level of secondary prevention for CHD. We based the current survey on the experience we had with a previous smaller audit conducted between 1998–99.¹

METHODS

The audit departments from the University Hospital of Wales in Cardiff, Llandough Hospital, Cardiff, Royal Gwent Hospital, Newport, and Prince Charles Hospital Merthyr Tydfil, assisted in our survey; each generated a list of patients discharged between 1 January and 31 December 1999 following a new MI (International classification of diseases, 10th revision (ICD-10) codes 121.0–121.4, 121.9, 122.0, 122.1, 122.8, 122.9). One hundred patients were randomly selected from each hospital. Pro-formas modified from our previous audit were completed to assess CHD secondary prevention. Each set of medical and nursing records was assessed independently by two specialist registrars. Pro-formas were then compared, differences discussed and, with further reference to the case notes, resolved.

Questionnaires (maximum of two) were then sent to surviving patients requesting a current medication …