Managing established coronary heart disease

The Department of Health's controversial banding system for promoting health in primary care was discontinued at the end of September 1996. Under the new arrangements for health promotion each practice has the opportunity to plan and develop its own effective health promotion strategy, based on the Health of the Nation and the needs of the practice's population. In any new strategy for promoting health, priority should go to implementing preventive measures in patients with established coronary heart disease, such as a history of myocardial infarction or stable angina or having undergone revascularisation by angioplasty or coronary artery bypass grafting. This view has been echoed by two recent reports on preventing coronary heart disease in primary care.1 2 The reasons are threefold. Firstly, patients with established coronary heart disease are at increased risk of subsequent vascular events (death, myocardial infarction, and stroke). In the British regional heart study 14% of 242 men with electrocardiographic signs of definite myocardial infarction had reinfarctions over the 4.2 year follow up, compared with only 2% of those with normal electrocardiograms.3 Secondly, these high risk patients amount to some two to three million people in Britain, and it has …