Follow up and target achievement in general practice of men at high risk of heart attack

Abstract

IN a study involving seven practices, the records of 292 men found to be at high risk of a heart attack were analysed twelve months after identification, to determine how far a protocol for follow up of patients was followed and the extent to which targets for risk reduction were achieved. It was found that 248 (84.9 per cent) had a further recording of one or more risk factors after identification at the screening examin ation. Follow up was most thorough for those with a raised blood pressure, and least complete for those with raised cholesterol. Of the 205 men with an in itially raised blood pressure, 153 achieved the target of 100 mm Hg or less at follow up, representing 75 per cent of the original group and 94 per cent of those followed up. Approximately 20 per cent of smokers and heavy drinkers identified at the screening exam ination reported achieving the target of cessation and safe drinking respectively at their last follow up. Rates of change for the overweight and those with raised cholesterol were no better than might be ex pected by chance. Overall these results compare favourably with previous studies. The use of proto cols, facilitator support and the motivational effect of knowledge of risk status may all have contributed. However, even with this level of support a significant number of patients was lost to follow up. Practices should give priority to achieving optimal rates of follow up for smoking and hypertension.