Prevalence and management of coronary heart disease in primary care: population-based cross-sectional study using a disease register

BACKGROUND: Patients with coronary heart disease are at high risk of further coronary events. Hence, one of the main priorities in the National Service Framework for Coronary Heart Disease strategy is the identification and treatment of patients with pre-existing coronary heart disease. We aimed to determine the prevalence of established coronary heart disease in a large primary care population and to compare the management of risk factors in these patients with the standards given in the National Service Framework. METHODS: A population-based cross-sectional study was carried out using data collected from primary care. Sixty-three general practices (total list size 378,021) in four primary care groups in SW London took part. Data collection was confined to 103,613 patients over 44 years of age. We calculated age- and sex-specific and age-standardized prevalence rates, and age-adjusted relative risks for men and women. RESULTS: A total of 6,778 patients with coronary heart disease were identified (8 per cent of men and 5 per cent of women over 44 years of age). There was a history of myocardial infarction in 30 per cent (1204/3991) of men and 22 per cent (613/2787) of women (relative risk 1.57; 1.37-1.81). Coronary revascularization procedures had been performed in 27 per cent (1068/3991) of men and 11 per cent (312/2787) of women (2.02; 1.73-2.35). Most patients had been assessed for hypertension (89 per cent (3538/3991) of men; 90 per cent (2500/ 2787) of women), but in many patients blood pressure was poorly controlled (26 per cent (902/3538) of men; 27 per cent (678/2500) of women). Total cholesterol had been recently measured in 51 per cent (2018/3991) of men and 44 per cent (1218/2787) of women and was elevated in 44 per cent (881/ 2018) of men and 59 per cent (716/1218) of women (0.74; 0.69-0.79). Statins were prescribed to 49 per cent (1967/3991) of men and 38 per cent (1064/2787) of women (1.06; 1.00-1.12). Aspirin was prescribed to 65 per cent (2586/3991) of men and 59 per cent (1631/2787) of women (1.08; 1.03-1.14). Beta-blockers were prescribed to 20 per cent (181/913) of men and 15 per cent (72/499) of women with a history of myocardial infarction (1.11; 0.85-1.44). CONCLUSIONS: Most patients with coronary heart disease in primary care were being treated with aspirin but less than half with statins or beta-blockers. More men than women were treated with aspirin and statins, even though women had higher cholesterol levels than men. Men were also more likely to have a confirmed diagnosis and to have undergone a coronary revascularization procedure. There is considerable scope for improving the secondary prevention of coronary heart disease and addressing gender inequalities in primary care.