Efficacy of an intensive prevention program in coronary patients in primary care, a randomised clinical trial.
BACKGROUND
Most studies that have analysed the effect of secondary prevention of coronary heart disease come from hospitals. Those that are community-based have been conducted mainly by nurses and follow-up was generally too short to show impact on cardiovascular events.


METHODS
This is a multi-centre randomised controlled clinical trial in which patients in the intervention group received periodic postal reminders to see their general practitioner every three months during a 3-year follow-up. General practitioners reinforced healthy lifestyle recommendations to patients and reviewed drug therapies at these quarterly intervals. Patients in the control group received usual care.


RESULTS
A total of 983 patients aged 30-79 were included. During the 3-year follow-up, 67 patients died and 156 experienced a non-fatal cardiovascular event. The event rates and all-cause mortality were similar in the intervention and control groups (24.0% and 23.5%, and 8.1% and 9.9%, respectively). Improvement in quality of life was similar in both groups. Blood pressure and high-density lipoprotein cholesterol were more frequently within recommended levels in the intervention group than in controls: odds ratio 1.63, 95% confidence interval 1.05-2.51, and odds ratio 2.61, 95% confidence interval 1.32-5.18, respectively.


CONCLUSIONS
Intensive secondary prevention conducted by general practitioners may improve long-term blood pressure control and increase high-density lipoprotein cholesterol in patients with stable coronary disease.
Munoz
Miguel-Angel
MA
Unitat Docent de Medicina Familiar i Comunitària Barcelona-Centre, Institut Català de la Salut, Barcelona, Spain.
Vila
Joan
J
Cabañero
Marta
M
Rebato
Carolina
C
Subirana
Isaac
I
Sala
Joan
J
Marrugat
Jaume
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D003327:Coronary Disease / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration*; D011336:Probability; D016730:Program Development; D015397:Program Evaluation; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000706:statistics & numerical data; D017010:Reminder Systems / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013030:Spain; D018709:Statistics, Nonparametric; D016019:Survival Analysis