REDUCING THE RISK AFTER CORONARY-ARTERY BYPASS-SURGERY - DOCUMENTATION OF RISK-FACTORS AND COMMUNICATION BETWEEN HOSPITAL AND GENERAL-PRACTICE

A retrospective descriptive study of patients who had had coronary art ery bypass surgery was carried out to assess the completeness of recor ding of risk factors in case notes in hospital and in general practice , and to determine the prevalence of documented risk factors in patien ts who have had coronary artery bypass surgery. Data from reviews of h ospital case notes and questionnaires to general practitioners were us ed to describe the frequency of documenting coronary risk factors and preventative advice in case notes and in correspondence between genera l practitioners and hospital doctors. Documentation of risk in hospita l records revealed that all 102 patients had been assessed for family history, hypertension and current smoking, but 9 (9%) had no record of serum cholesterol, 35 (34%) patients did not have a record of their b lood glucose, and in 83 (81%) patients there was no evidence that obes ity had been assessed. Documentation of risk factors in general practi ce records identified that out of 77 patients, all had their blood pre ssure and smoking status recorded but 29 (38%) had not been assessed f or hypercholesterolaemia. From the hospital records, the prevalence of risk factors in the sample population was 41% for hypertension or rai sed blood pressure, 49% for hypercholesterolaemia, 12% for current smo king and 8% for diabetes mellitus. In conclusion, patients who have ha d coronary artery bypass surgery have substantial needs for secondary prevention. A more structured approach to risk factor assessment and p reventative care should begin as soon as the diagnosis of coronary hea rt disease is made, and should not be postponed until the patient has deteriorated to the point of needing bypass surgery.