Reductions in risk factors for secondary prevention of coronary heart disease by ethnic group in south-west London: 10-year longitudinal study (1998-2007)

Abstract

Objectives: To explore trends by ethnicity in clinical risk factor recording and control among patients with coronary heart disease (CHD), during a period of major investment in quality improvement initiatives in general practice in England.

Design: Longitudinal study from 1998 to 2007, using general practice data extracted from electronic patient records of all adult patients (n=177,412) registered in 2007.

Setting: Twenty-nine general practices in Wandsworth south-west London.

Subjects: Three thousand two hundred registered patients with a recorded diagnosis of CHD, in 2007.

Main outcome measures: Mean systolic and diastolic blood pressure and mean cholesterol of patients with CHD, for each calendar year.

Results: From 1998 to 2007, the proportion of patients with CHD who had their blood pressure recorded rose from 33.2% to 93.9% and cholesterol from 21.7% to 83.5%. Over this period, mean blood pressure decreased from 140/80 to 133/74 mmHg (P<0.001). There was a reduction in mean cholesterol from 5.2 to 4.3 mmol/l (P<0.001). Reductions in mean blood pressure and cholesterol occurred across all ethnic groups.

Conclusions: From 1998 to 2007, risk factor control among patients with CHD improved, with reductions in their mean blood pressure and cholesterol across all ethnic groups. Widespread policy change has helped to improve the quality and equity of primary care for heart disease patients. Health improvements predated implementation of the Quality and Outcomes Framework and have since continued. Our findings illustrate how a national health care system with universal coverage can significantly reduce inequalities and improve chronic disease care for all ethnic groups.