Secondary prevention clinics for coronary heart disease: randomised trial of effect on health

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Abstract
Objective: To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease. Design: Randomised controlled trial of clinics over one year with assessment by self completed postal questionnaires and audit of medical records at the start and end of the trial. Setting: Random sample of 19 general practices in northeast Scotland. Subjects: 1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease who did not have terminal illness or dementia and were not housebound. Intervention: Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up. Main outcome measures: Health status measured by the SF-36 questionnaire, chest pain by the angina type specification, and anxiety and depression by the hospital anxiety and depression scale. Use of health services before and during the study. Results: There were significant improvements in six of eight health status domains (all functioning scales, pain, and general health) among patients attending the clinic. Role limitations attributed to physical problems improved most (adjusted difference 8.52, 95% confidence interval 4.16 to 12.9). Fewer patients reported worsening chest pain (odds ratio 0.59, 95% confidence interval 0.37 to 0.94). There were no significant effects on anxiety or depression. Fewer intervention group patients required hospital admissions (0.64, 0.48 to 0.86), but general practitioner consultation rates did not alter. Conclusions: Within their first year secondary prevention clinics improved patients' health and reduced hospital admissions. Nurse led clinics in general practice were used to promote secondary prevention to patients with coronary heart disease Within the first year the health of patients invited to the clinics improved Most benefit was in functional status, but chest pain improved too There was no effects on anxiety or depression There were significant reductions in hospital admissions in the first year