There were no significant effects of interventions on mean blood pressure or cholesterol levels , prescribing , smoking status or body mass index .
There was some suggestion of a " ceiling effect " whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached .
There is weak evidence that regular planned recall of patients for appointments , structured monitoring of risk factors and prescribing , and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure .
BACKGROUND Ischaemic heart disease ( IHD ) is a major cause of mortality and morbidity and its prevalence is set to increase .
Secondary prevention aims to prevent subsequent acute events in people with established IHD .
While the benefits of individual medical and lifestyle interventions is established , the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community setting s is less so .
OBJECTIVES To assess the effectiveness of service organisation interventions , identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring ( blood pressure , cholesterol and lifestyle factors such as diet , exercise , smoking and obesity ) and appropriate prophylactic medication .
Do patients with angina alone have a more benign prognosis than patients with a history of acute myocardial infarction, revascularisation or both? Findings from a community cohort study
Aim : To compare prognosis for patients with a diagnosis of angina alone to patients postacute myocardial infa rct ion ( AMI ) and /or revascularisation and /or angina . Design : Community-based retrospective cohort study . Setting : A r and om selection of 37 Irish general practice s. Participants : 1,609 adults with ischaemic heart disease ( IHD ) identified in 2000/1 . Intervention : Medical records search es and postal question naires in 2000/1 and 2005/6 . Outcome measures : Primary : all-cause and IHD-related mortality . Secondary :  acute myocardial infa rct ion ( AMI ) , cardiac artery bypass grafting ( CABG ) and percutaneous transluminal coronary angioplasty ( PTCA ) ; physical and mental health status as measured by SF36 and SF12 ; process of care measurements and behavioural risk factor outcomes . Results : Compared with patients with previous AMI and /or revascularisation , patients with angina alone had slightly lower risks of all-cause and IHD-related death : however , although hazard ratios of 0.73 ( 95 % CI 0.55 to 0.98 ) and 0.65 ( 95 % CI 0.44 to 0.98 ) , respectively , were significant at the p<0.05 level , they were not significant at the p<0.01 level currently suggested as appropriate in observational research . Proportional hazards models identified no statistically significant differences in adjusted risks of subsequent AMI , CABG or PTCA between patients with angina-alone and those with other IHD . Over the 4.5-year follow-up , physical functioning was consistently lower among those with angina alone , and the extent to which physical functioning was increasingly impaired was slightly greater . Conclusions : Prognosis to death or cardiac outcomes for patients with angina alone was similar to those with previous AMI and /or revascularisation , while health status was poorer . The clinical importance of angina should not be underestimated in primary care . Further descriptive research is needed among representative community cohorts of people with angina
There were no significant effects of interventions on mean blood pressure or cholesterol levels , prescribing , smoking status or body mass index .
There was some suggestion of a " ceiling effect " whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached .
There is weak evidence that regular planned recall of patients for appointments , structured monitoring of risk factors and prescribing , and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure .
BACKGROUND Ischaemic heart disease ( IHD ) is a major cause of mortality and morbidity and its prevalence is set to increase .
Secondary prevention aims to prevent subsequent acute events in people with established IHD .
While the benefits of individual medical and lifestyle interventions is established , the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community setting s is less so .
OBJECTIVES To assess the effectiveness of service organisation interventions , identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring ( blood pressure , cholesterol and lifestyle factors such as diet , exercise , smoking and obesity ) and appropriate prophylactic medication .