Secondary prevention clinics: improving quality of life and outcome

Abstract

General practitioners have been encouraged to target patients with coronary heart disease for secondary prevention, but putting this into practice has proven challenging. However, there is now evidence of the benefits from nurse led clinics in primary care. Randomised trials have shown that such clinics can lead to improvement in both medical and lifestyle components of secondary prevention. This has in turn been associated with improved quality of life and a reduction in mortality. Benefits are conditional on several factors: in particular, risk factors are only reduced if clinic attendance is accompanied by appropriate prescribing, and improvements in risk factors are only sustained if the clinics are continued.

Figure 1

Effect of nurse led clinics on health behaviour. The figure shows the percentage improvement in the intervention group compared to the control group (comparing mean scores for diet in Belfast and Maryland and proportions reaching targets elsewhere).

Figure 2

Effect of nurse led clinics on drug treatment and risk factors. The figure shows the percentage improvement in the intervention group compared to the control group (mean values for total cholesterol and systolic blood pressure are compared for the Belfast and Maryland studies and proportions on treatment or reaching targets elsewhere).

Figure 3

Effect of nurse led clinic on quality of life—percentage change in SF-36 scores, clinic versus control. Higher score represents improvement.⁵

Figure 4

Effect of nurse led clinic on total deaths. Adapted from Murchie et al⁶ with permission. CI, confidence interval; RR, relative risk.