Medical treatment and secondary prevention of coronary heart disease in general practice in Iceland.
OBJECTIVE
To evaluate the implementation of secondary prevention and treatment of coronary heart disease (CHD) in general practice in Iceland.


METHODS
Two health care centers adjacent to Reykjavik with a total of 25766 inhabitants.


METHODS
All patients (533) with CHD living in the study area were sent an invitation letter and a request for informed consent. Those who chose to participate answered a questionnaire about CHD risk factors and their current treatment, and their medical records were reviewed. The patients were divided into four groups on the basis of their history: I. Coronary artery bypass surgery (CABG), II. Percutaneous transluminal coronary angioplasty (PTCA), III. Myocardial infarction (MI), IV. Angina pectoris (AP). If a patient fulfilled the criteria for more than one diagnostic group the CABG group had the highest priority followed by PTCA, MI and finally AP.


METHODS
Blood pressure, smoking habits, BMI, exercise profile, cholesterol levels and drug therapy.


RESULTS
Of 533 patients with CHD, 402 (75%) participated in the study, 15% were managed exclusively by their family physician and 23% by both cardiologists and family physicians. Obesity was relatively common, with nearly 60% being overweight (BMI > 25). Average cholesterol in the total group was 6.2 mmol/L (95% CI 6.07 to 6.34). Blood pressure had been recorded in 92% of the patients, and mean systolic and diastolic blood pressures were 143 and 82 mmHg, respectively. While 15% were current smokers, 56% were ex-smokers. A total of 113 patients (28%) were being treated with cholesterol-lowering drug therapy at the time of the study. Respective treatment ratios in the four subgroups were 47% in group I, 42% in II, 25% in III and 13% in group IV. Aspirin was taken by 284 patients (71%), beta blockers by 52% and calcium channel blockers by 36%. More than twice as many women than men were treated with nitrates, 57% versus 27%.


CONCLUSIONS
The results indicate that there are numerous possibilities for improvements in secondary prevention and medical management of coronary heart disease in Iceland. Particular emphasis should be placed on smoking cessation, life-style modification with exercise and diet recommendations to lower BMI and lipid-lowering therapy.
Sigurdsson
Emil L
EL
Health Center of Hafnarfjordur, University of Iceland. emilsig@solvangur.hgst.is
Jónsson
Jón Steinar
JS
Thorgeirsson
Gudmundur
G
D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D004363:Drug Utilization; D015444:Exercise; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications; D007055:Iceland / Q000453:epidemiology; D008297:Male; D020380:Needs Assessment / Q000458:organization & administration; D009765:Obesity / Q000150:complications; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
D000924:Anticholesteremic Agents; D002317:Cardiovascular Agents