title: Effects of secondary prevention clinics on health status in patients with coronary heart disease: 4 year follow-up of a randomized trial in primary care.
abstract: BACKGROUND
  The long-term effects of disease management programmes for coronary heart disease on health status are unknown. In a randomized trial of nurse-led secondary prevention clinics, we found significantly improved health status at 1 year. Participants were followed-up again at 4 years to determine if improvements had been sustained.
  
  
  OBJECTIVE
  Our aim was to evaluate the effects on health of nurse-led clinics for the secondary prevention of coronary heart disease in primary care.
  
  
  METHODS
  A total of 1343 patients with coronary heart disease were randomized to nurse-led secondary prevention clinics or usual care, with follow-up at 1 and 4 years by review of medical case notes and national data sets, and postal questionnaires. The study involved a stratified, random sample of 19 general practices in north-east Scotland. Health status was measured by the SF-36 questionnaire, chest pain by the angina TyPE specification and anxiety and depression by the hospital anxiety and depression scale.
  
  
  RESULTS
  At 1 year, there were significant improvements in five of eight SF-36 domains (all functioning scales, pain and general health) in patients randomized to clinics. Role limitations attributed to physical problems improved the most [adjusted difference 8.52, 95% confidence interval (CI) 4.16-12.9]. At 4 years, the intervention group scored higher than control in all domains, but differences were no longer significant. At 1 year, fewer patients in the intervention group reported worsening chest pain (odds ratio 0.59, 95% C1 0.37-0.94). At 4 years, there were no significant differences between the proportion of intervention or control group patients who reported chest pain in the last week or who reported worsening chest pain. No significant effects were observed on anxiety or depression at 1 or 4 years.
  
  
  CONCLUSIONS
  We have demonstrated previously a significantly greater survival in attendees at nurse-led secondary prevention clinics. Despite this, improvements in health status achieved in the first year of the study were reduced at 4 years. The case for nurse-led clinics remains strong, but further research is required on ways to optimize current health status.
authors.affiliation: Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY. p.murchie@abdn.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Murchie
authors.forename: Neil C
authors.initials: NC
authors.lastname: Campbell
authors.forename: Lewis D
authors.initials: LD
authors.lastname: Ritchie
authors.forename: H George
authors.initials: HG
authors.lastname: Deans
authors.forename: Joan
authors.initials: J
authors.lastname: Thain
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D002637:Chest Pain / Q000453:epidemiology / Q000517:prevention & control; D003327:Coronary Disease / Q000453:epidemiology / Q000451:nursing / Q000517:prevention & control*; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D009722:Nurse Practitioners; D011320:Primary Health Care / Q000458:organization & administration*; D012606:Scotland / Q000453:epidemiology