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Secondary prevention of CHD ‘must be optimized early’

Heart 2008; 94: 1419–1423



The early benefit of nurse-led clinics for patients with coronary heart disease (CHD) is lost after 10 years, research indicates, supporting the view that secondary prevention efforts should be optimized immediately upon diagnosis.

The finding is derived from long-term follow-up of a randomized controlled trial that assessed the impact of nurse-led secondary prevention clinics on total mortality and coronary events (nonfatal myocardial infarction and coronary death). The study cohort comprised 1343 patients, aged up to 80 years, with a diagnosis of CHD.

A previous study found that nurse-led clinics produced significant improvements in lifestyle and medical components of secondary prevention and quality of life 1 year after randomization. And at 4 years, nurse-led clinics were associated with significantly fewer deaths and coronary events.

In the latest report, which appears in the journal Heart, Elizabeth Delaney (University of Aberdeen, UK) and team analyzed study outcomes after ten years of follow-up.

They found that the cumulative deaths rates were 38% and 41% in the intervention and control groups, respectively, a non-significant difference. Rates of coronary events were identical, at 19.1%, in each group.

After adjusting for age, gender, and general practice, the hazard ratios were 0.88 for total mortality and 0.96 for coronary events, neither of which were statistically significant. There were no significant differences in the causes of death at either 4 or 10 years.

Delaney et al say their findings support the view that patients should have secondary prevention optimized without delay upon receiving a diagnosis of CHD.

“Any delay may compromise their medium- to long-term survival,” they write. “It is incumbent upon policy makers and health professionals to ensure that processes of care are organized to permit optimization of secondary prevention for CHD at the very earliest stage.”

In an accompanying editorial, the authors stress the importance of CHD prevention and say it is “well worth doing despite the difficulty.”

“Secondary prevention still glistens as the jewel in the cardiovascular prevention crown,” they write. “Questions about its long-term effectiveness and optimal mix of components remain as a research and clinical priority.”

Read the abstract