Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care
Open accessAbstract
Objective: To evaluate whether nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease. Design: Randomised controlled trial. Setting: A random sample of 19 general practices in northeast Scotland. Patients: 1173 patients (685 men and 488 women) under 80 years with working diagnoses of coronary heart disease, but without terminal illness or dementia and not housebound. Intervention: Nurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up. Main outcome measures: Components of secondary prevention assessed at baseline and one year were: aspirin use; blood pressure management; lipid management; physical activity; dietary fat; and smoking status. A cumulative score was generated by counting the number of appropriate components of secondary prevention for each patient. Results: There were significant improvements in aspirin management (odds ratio 3.22, 95% confidence interval 2.15 to 4.80), blood pressure management (5.32, 3.01 to 9.41), lipid management (3.19, 2.39 to 4.26), physical activity (1.67, 1.23 to 2.26) and diet (1.47, 1.10 to 1.96). There was no effect on smoking cessation (0.78, 0.47 to 1.28). Of six possible components of secondary prevention, the baseline mean was 3.27. The adjusted mean improvement attributable to intervention was 0.55 of a component (0.44 to 0.67). Improvement was found regardless of practice baseline performance. Conclusions: Nurse run clinics proved practical to implement in general practice and effectively increased secondary prevention in coronary heart disease. Most patients gained at least one effective component of secondary prevention and, for them, future cardiovascular events and mortality could be reduced by up to a third.
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Other studies have demonstrated the effectiveness of nurse-led prevention clinics in primary care compared with usual care, with greater success in secondary as opposed to primary prevention.
“Other studies have demonstrated the effectiveness of nurse-led prevention clinics in primary care compared with usual care, with greater success in secondary as opposed to primary prevention.532 -534”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [533]
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- Authors
- Campbell, N. C., Ritchie, L. D., Thain, J., Deans, H. G., Rawles, J. M., & Squair, J. L.
- Affiliations
- aDepartment of General Practice and Primary Care, Foresterhill Health Centre, Aberdeen, UK, bDenburn Health Centre, Rosemount Viaduct, Aberdeen, UK, cMedicines Assessment Research Unit, Medical School, Foresterhill, Aberdeen, UK, dDepartment of Public Health, Medical School, Foresterhill, Aberdeen, UK
- Corresponding author
- Campbell, N C
- Venue
- Heart
- Publisher
- BMJ
- Published
- 1998-11-01
- Volume
- 80
- Issue
- 5
- Pages
- 447-452
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- PMC
- PMC1728827
- OpenAlex
- W2129836013
- Cited by
- 258
- References
- 24
- Citations by year
- 2025: 1 · 2024: 6 · 2023: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 9 · 2016: 5 · 2015: 10 · 2014: 6 · 2013: 10 · 2012: 15
- FWCI
- 13.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Keywords
- coronary artery disease, secondary prevention, nurse-led clinics, general practice, aspirin use, blood pressure control, lipid control, physical activity, dietary fat, smoking cessation, cardiovascular risk factors, primary care
- MeSH terms
- Aged, Ambulatory Care Facilities, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Coronary Disease, Dietary Fats, Female, Humans, Hypertension, Lipids, Male, Middle Aged, Nurse Clinicians, Patient Compliance, Patient Education as Topic, Odds Ratio, Smoking Cessation
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