Secondary prevention of coronary heart disease in a sample of primary care practices in eastern England: evidence of unmet need
Objective: To investigate prevalence of risk factors and use of secondary prevention strategies for recurrent coronary heart disease (CHD) in primary care. Design: Cross-sectional study of a 50% sample of medical records. Subjects: Patients aged 35-75 years with a record of coronary heart disease from 13 primary care practices in eastern England. Main outcome measures: Recorded prevalence of smoking, body mass index and use of aspirin, beta-blockers and statins. Results: Records were reviewed for 1205 patients with CHD of whom 76% were over 60 years of age and 34% were women. Crude age-specific prevalence of CHD was 4.1%. CHD was categorised as angina (52% of subjects), past myocardial infarction (33% of subjects) and history of coronary revascularisation (15% of subjects). Prevalence of smoking and obesity (body mass index >30kg/m 2 ) was based on available data for 1080 and 973 subjects and was 23% and 31% respectively. Seventy percent of all subjects were recorded as receiving aspirin, 40% were being prescribed beta-blockers and 37% were being prescribed statins. These proportions varied by age, sex and category of CHD. Conclusion: Despite evidence of effectiveness most strategies for reducing risk of recurrent coronary heart disease are still not widely used in primary care. Possible explanations include absence of systematic care for CHD patients, limited availability of behavioral interventions and concerns over the cost of treatment. National guidelines for secondary prevention of CHD in primary care are being developed.