title: Secondary prevention clinics for coronary heart disease: randomised trial of effect on health.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Random sample of 19 general practices in northeast Scotland.
  
  
  METHODS
  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.
  
  
  METHODS
  Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up.
  
  
  METHODS
  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.
authors.affiliation: Department of General Practice and Primary Care, Foresterhill Health Centre, Aberdeen AB25 2AY. n.campbell@abdn.ac.uk
authors.forename: N C
authors.initials: NC
authors.lastname: Campbell
authors.forename: J
authors.initials: J
authors.lastname: Thain
authors.forename: H G
authors.initials: HG
authors.lastname: Deans
authors.forename: L D
authors.initials: LD
authors.lastname: Ritchie
authors.forename: J M
authors.initials: JM
authors.lastname: Rawles
authors.forename: J L
authors.initials: JL
authors.lastname: Squair
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration; D001007:Anxiety / Q000209:etiology; D002637:Chest Pain / Q000517:prevention & control; D003327:Coronary Disease / Q000451:nursing / Q000517:prevention & control*; D003863:Depression / Q000209:etiology; D005194:Family Practice; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012606:Scotland / Q000453:epidemiology; D017211:Treatment Failure