Primary care nursing of coronary patients and reduction of re-infarction risk: a nested case-control study.
OBJECTIVE
To estimate the risk reduction for re-infarction achieved in primary health care centres.


METHODS
This was a case-control study nested in a cohort of coronary patients.


METHODS
Nine hundred and eighty-five coronary patients, aged less than 76 years who had survived for more than 6 months after their first acute myocardial infarction (AMI), were recruited from two public hospitals in Navarre, Spain. Cases (repeated myocardial infarction, n = 137) and controls (patients with one AMI who had not had a second infarction, [n = 137) who had not been treated with invasive procedures were extracted from this cohort and matched by gender, age, hospital and the secondary prevention time frame.


METHODS
Re-infarction.


RESULTS
In total, 31.4% of cases and 51.8% of controls attended the primary care nurse clinic regularly. This difference accounted for a significant reduction of the risk of re-infarction, even after adjustment for regular visits to the family physician, life styles (smoking, walking habit and dietary changes) and drug treatments (odds ratio: 0.48; 95% confidence interval: 0.26-0.89). A regular schedule of visits to the family physician showed no association with further coronary risk reduction.


CONCLUSIONS
Regular attendance of coronary patients at a primary care nurse clinic is associated with a lower risk for re-infarction. Psychological rehabilitation could be the main reason for this benefit, since protection persists after adjustments for other known risk factors.
Serrano-Martínez
M
M
Department of Epidemiology and Public Health, School of Medicine, University of Navarre, Irunlarrea s/n, 31080 Pamplona, Spain. mserranm@nacom.es
Sanjulián-Aranguren
B
B
Ezpeleta-Iturralde
I
I
Madoz-Zubillaga
E
E
Urbina Goñi
M J
MJ
de Irala-Estevez
J
J
D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003327:Coronary Disease / Q000451:nursing* / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011321:Primary Nursing / Q000706:statistics & numerical data*; D012008:Recurrence; D040242:Risk Reduction Behavior; D013030:Spain / Q000453:epidemiology