Continuation and initiation of preventive care in general practice following myocardial infarction
Wright FL., Dovey SM., Lancaster T., Hicks NR., Mant D., Neil HAW.
This study assesses the extent to which general practitioners maintain hospital-initiated preventive treatment for patients one year after a myocardial infarction and initiate preventive care for patients discharged from hospital without such care. A cross-sectional study was conducted following up 565 myocardial infarction one-year survivors aged less than 80 years from two district general hospitals and 97 general practices in Oxfordshire and bordering areas. Hospital discharge records and general practice casenotes were reviewed for prescriptions of aspirin, β-blockers, ACE inhibitors, and lipid-lowering drugs. The number of patients continuing to receive hospital-initiated prescriptions one year after the acute event was: for aspirin 437/466(94%); β-blockers 217/276(79%); ACE-inhibitors 189/218 (87%) and lipid lowering drugs 57/66 (86%). The number of patients discharged without appropriate preventive care but receiving prescriptions initiated in general practice was: for aspirin 30/40 (75%); β-blockers 49/169 (27%); ACE-inhibitors 11/20 (55%) and lipid-lowering drugs 81/261 (31%). In conclusion, improving the implementation of evidence-based preventive care for patients with coronary heart disease is now a national priority. Most post-infarction patients were managed to a high standard, but the highest rates were attained when prescribing was initiated in hospital. Achieving optimal preventive care at hospital discharge is a crucial step in achieving appropriate long-term care in general practice. © 2001 Harcourt Publishers Ltd.