Evaluation of a cardiac prevention and rehabilitation programme for all patients at first presentation with coronary artery disease

Abstract

Background: A cardiac prevention and rehabilitation (CP&R) programme was established for patients following their first clinical episode of coronary heart disease and 1-year outcomes were evaluated against British targets for coronary prevention.

Methods: Patients were evaluated 1 year after participation and outcomes compared with patients in the same health district registered with a random half of general practitioners not eligible for the programme (internal reference group) and patients identified in other English centres which participated in the EUROASPIRE II survey (external reference group).

Results: Three hundred and eighteen patients (76% of 417 incident cases) attended for 1-year screening. Of those who participated in the programme 96/113 (85%) attended (Group 1); 152/194 (78%) attended from all those eligible for the programme (Group 2); 166/223 (74%) attended from those receiving usual care in the same health district (Group 3 - internal reference group). In the EUROASPIRE II survey (Group 4 - external reference group) 362/744 (58%) patients were screened. Current smoking at follow-up was Group 1, 8%, Group 2, 11%, Group 3, 13% and Group 4, 18%. Proportions with a BMI < 25 kg/m were 29%, 25%, 32%, 18%; BP < 140/90 mmHg 58%, 56%, 49%, 48%; total cholesterol < 5.0 mmol/l 60%, 54%, 43%, 46%; antiplatelet therapy 88%, 87%, 86%, 81%; beta-blocker therapy 48%, 46%, 46%, 44%; and lipid lowering therapy 56%, 51%, 36%, 69% respectively.

Conclusions: A CP&R programme was associated with a majority of coronary patients, whether attending the programme or not, achieving the Joint British Society's recommended prevention targets within the same health district. Specifically, a higher proportion of programme patients reached the cholesterol target of <5.0 mmol/l compared with both usual care and other centres elsewhere. This was achieved by using more lipid lowering therapy compared with usual care in the same health district, but less than other centres outside the health district. The overall results for the whole health district show a higher standard of preventive care compared with contemporary EUROASPIRE II results from other health districts in England.