PEARLS 265, May 2010, written by Brian R McAvoy

Clinical question

How effective are service organisation interventions for management of secondary prevention of ischaemic heart disease (IHD) in primary care?  

Bottom line

There is weak evidence that regular planned recall of patients for appointments, structured monitoring of medications and risk factors (such as blood pressure [BP], cholesterol and lifestyle factors such as diet, smoking and obesity) and patient secondary prevention education can be effective in improving patient compliance with recommendations on blood cholesterol and BP levels. There were no significant effects of interventions in mean BP or cholesterol levels, prescribing, smoking status or body mass index.  

Caveat

Caution must be exercised in interpreting these results because of the significant heterogeneity between studies. Few trials measured the same outcomes. Limited data were available on the effect on diet. There were insufficient studies or data to suggest the effectiveness of interventions is affected by the type of lead primary care professional. There was some evidence of a ceiling effect, whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached.  

Context

IHD is a major cause of mortality and morbidity. Secondary prevention aims to prevent subsequent acute events in people with established IHD. While the benefits of individual medical and lifestyle interventions are established, the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community settings is less certain.  

Cochrane Systematic Review

Buckley BS et al. Service organisation for the secondary prevention of ischaemic heart disease in primary care. Cochrane Reviews 2010, Issue 3. Article No. CD0057503. DOI: 10.1002/14651858.CD007503.pub2. This review contains 11 studies involving 12,074 participants.