Secondary prevention clinics for coronary heart disease

a 10-year follow-up of a randomised controlled trial in primary care

E. K. Delaney, P. Murchie, A. J. Lee, L. D. Ritchie, N. C. Campbell

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives: To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease (CHD) 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 northeast Scotland.

Participants: Original study cohort of 1343 patients, aged,80 years, with a working diagnosis of CHD, 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 1 year,

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

Results: Mean (SD) follow-up was at 10.2 (0.19) years. No significant differences in total mortality or coronary events were found 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). When Kaplan-Meier survival analysis, adjusted for age, sex and general practice, was used, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.18) for coronary death or non-fatal MI. No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years.

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

Original languageEnglish
Pages (from-to)1419-1423
Number of pages5
JournalHeart
Volume94
Issue number11
Early online date15 Jan 2008
DOIs
Publication statusPublished - Nov 2008

Keywords

  • high cardiovascular risk
  • health-promotion
  • general-practice
  • management
  • programs

Cite this

Secondary prevention clinics for coronary heart disease : a 10-year follow-up of a randomised controlled trial in primary care. / Delaney, E. K.; Murchie, P.; Lee, A. J.; Ritchie, L. D.; Campbell, N. C.

In: Heart, Vol. 94, No. 11, 11.2008, p. 1419-1423.

Research output: Contribution to journalArticle

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abstract = "Objectives: To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease (CHD) 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 northeast Scotland.Participants: Original study cohort of 1343 patients, aged,80 years, with a working diagnosis of CHD, 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 1 year,Main outcome measures: Total mortality and coronary events (non-fatal myocardial infarctions (MIs) and coronary deaths).Results: Mean (SD) follow-up was at 10.2 (0.19) years. No significant differences in total mortality or coronary events were found 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). When Kaplan-Meier survival analysis, adjusted for age, sex and general practice, was used, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.18) for coronary death or non-fatal MI. No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years.Conclusions: After 10 years, differences between groups were no longer significant. Total mortality survival curves for the intervention and control groups had not converged, but the coronary event survival curves had. Possibly, therefore, the earlier that secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal.",
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T1 - Secondary prevention clinics for coronary heart disease

T2 - a 10-year follow-up of a randomised controlled trial in primary care

AU - Delaney, E. K.

AU - Murchie, P.

AU - Lee, A. J.

AU - Ritchie, L. D.

AU - Campbell, N. C.

PY - 2008/11

Y1 - 2008/11

N2 - Objectives: To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease (CHD) 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 northeast Scotland.Participants: Original study cohort of 1343 patients, aged,80 years, with a working diagnosis of CHD, 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 1 year,Main outcome measures: Total mortality and coronary events (non-fatal myocardial infarctions (MIs) and coronary deaths).Results: Mean (SD) follow-up was at 10.2 (0.19) years. No significant differences in total mortality or coronary events were found 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). When Kaplan-Meier survival analysis, adjusted for age, sex and general practice, was used, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.18) for coronary death or non-fatal MI. No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years.Conclusions: After 10 years, differences between groups were no longer significant. Total mortality survival curves for the intervention and control groups had not converged, but the coronary event survival curves had. Possibly, therefore, the earlier that secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal.

AB - Objectives: To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease (CHD) 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 northeast Scotland.Participants: Original study cohort of 1343 patients, aged,80 years, with a working diagnosis of CHD, 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 1 year,Main outcome measures: Total mortality and coronary events (non-fatal myocardial infarctions (MIs) and coronary deaths).Results: Mean (SD) follow-up was at 10.2 (0.19) years. No significant differences in total mortality or coronary events were found 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). When Kaplan-Meier survival analysis, adjusted for age, sex and general practice, was used, proportional hazard ratios were 0.88 (0.74 to 1.04) for total mortality and 0.96 (0.79 to 1.18) for coronary death or non-fatal MI. No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years.Conclusions: After 10 years, differences between groups were no longer significant. Total mortality survival curves for the intervention and control groups had not converged, but the coronary event survival curves had. Possibly, therefore, the earlier that secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal.

KW - high cardiovascular risk

KW - health-promotion

KW - general-practice

KW - management

KW - programs

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DO - 10.1136/hrt.2007.126144

M3 - Article

VL - 94

SP - 1419

EP - 1423

JO - Heart

JF - Heart

SN - 1355-6037

IS - 11

ER -