Background A cardiac prevention and rehabilitation (CP&R)
programme was established for patients following their first clinical episode of
coronary heart disease and 1-year outcomes were evaluated against British
targets for coronary prevention.
Methods Patients were evaluated 1 year after participation and
outcomes compared with patients in the same health district registered with a
random half of general practitioners not eligible for the programme (internal
reference group) and patients identified in other English centres which
participated in the EUROASPIRE II survey (external reference group).
Results Three hundred and eighteen patients (76% of 417
incident cases) attended for 1-year screening. Of those who participated in the
programme 96/113 (85%) attended (Group 1); 152/194 (78%)
attended from all those eligible for the programme (Group 2); 166/223
(74%) attended from those receiving usual care in the same health
district (Group 3 – internal reference group). In the EUROASPIRE II
survey (Group 4 – external reference group) 362/744 (58%)
patients were screened. Current smoking at follow-up was Group 1, 8%,
Group 2, 11%, Group 3, 13% and Group 4, 18%.
Proportions with a BMI < 25 kg/m2 were 29%,
25%, 32%, 18%; BP < 140/90 mmHg
58%, 56%, 49%, 48%; total
cholesterol < 5.0 mmol/l 60%, 54%,
43%, 46%; antiplatelet therapy 88%,
87%, 86%, 81%; β-blocker therapy
48%, 46%, 46%, 44%; and lipid
lowering therapy 56%, 51%, 36%, 69%
respectively.
Conclusions A CP&R programme was associated with a
majority of coronary patients, whether attending the programme or not, achieving
the Joint British Society's recommended prevention targets within the
same health district. Specifically, a higher proportion of programme patients
reached the cholesterol target of <5.0 mmol/l compared with both
usual care and other centres elsewhere. This was achieved by using more lipid
lowering therapy compared with usual care in the same health district, but less
than other centres outside the health district. The overall results for the
whole health district show a higher standard of preventive care compared with
contemporary EUROASPIRE II results from other health districts in England.
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