Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial.
OBJECTIVE
To evaluate the effect of a disease management programme for patients with coronary heart disease (CHD) and chronic heart failure (CHF) in primary care.


METHODS
A cluster randomised controlled trial of 1316 patients with CHD and CHF from 20 primary care practices in the UK was carried out. Care in the intervention practices was delivered by specialist nurses trained in the management of patients with CHD and CHF. Usual care was delivered by the primary healthcare team in the control practices.


RESULTS
At follow up, significantly more patients with a history of myocardial infarction in the intervention group were prescribed a beta-blocker compared to the control group (adjusted OR 1.43, 95% CI 1.19 to 1.99). Significantly more patients with CHD in the intervention group had adequate management of their blood pressure (<140/85 mm Hg) (OR 1.61, 95% CI 1.22 to 2.13) and their cholesterol (<5 mmol/l) (OR 1.58, 95% CI 1.05 to 2.37) compared to those in the control group. Significantly more patients with an unconfirmed diagnosis of CHF had a diagnosis of left ventricular systolic dysfunction confirmed (OR 4.69, 95% CI 1.88 to 11.66) or excluded (OR 3.80, 95% CI 1.50 to 9.64) in the intervention group compared to the control group. There were significant improvements in some quality-of-life measures in patients with CHD in the intervention group.


CONCLUSIONS
Disease management programmes can lead to improvements in the care of patients with CHD and presumed CHF in primary care.
Khunti
Kamlesh
K
Department of Health Sciences, University of Leicester, UK. kk22@le.ac.uk
Stone
Margaret
M
Paul
Sanjoy
S
Baines
Jan
J
Gisborne
Louise
L
Farooqi
Azhar
A
Luan
Xiujie
X
Squire
Iain
I
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000628:therapy*; D019468:Disease Management; D004363:Drug Utilization; D004739:England; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D002784:Cholesterol