Management of ischaemic heart disease in primary care: towards better practice

Background Ischaemic heart disease is the commonest cause of mortality in t he United Kingdom. The objective of this study was To assess the management of patients with ischaemic heart disease in primary care, focusing particu larly on the management of hypercholesterolaemia. Methods A cross-sectional survey was carried out of the clinical records of patients aged 25-74 years with confirmed ischaemic heart disease in six ge neral practices (total list size 56 600). Results Recording of risk factors varied from 97 per cent for blood pressur e to 73 per cent for cholesterol measurement. Seventy-two per cent of the p atients had adequate blood pressure control, based on their last recorded b lood pressure. Sixty-one per cent (267) were known to be taking aspirin dai ly and 29 per cent (125) had undergone revascularization treatment. Sixty-e ight per cent (296) of the patients had pre-treatment cholesterol levels of 5.5 mmol/l or greater and 34 per cent (147) were currently taking lipid lo wering drugs. Statins were the most commonly used cholesterol lowering agen ts and were being taken by 30 per cent (131) of the patients. Patients who had undergone revascularization treatment had levels of recording of risk f actors similar to other patients with ischaemic heart disease but were more likely to be taking daily aspirin (71 per cent versus 57 per cent, relativ e risk 1.24, 95 per cent confidence intervals (CI)1.07-1.44). The mean pre- treatment cholesterol was 6.49 mmol/l and the mean post-treatment cholester ol 5.80 mmol/l (difference 0.69 mmol/l, 95 per cent Cl 0.55-0.84 mmol/l). Conclusions Systematic searches of computerized ana paper medical records c an identify subgroups of patients who wilt benefit from continuing follow-u p in primary care. The results of this study suggest that ischaemic heart d isease remains an area where there is scope to improve the management of pa tients in primary care. Considerable effort will be required from the membe rs of the primary health care team to achieve this objective, particularly in the areas of computerized data collection and in the identification and recall of patients.