Ten year audit of secondary prevention in coronary bypass patients
Treatment of risk factors in patients who have had coronary bypass surgery has improved considerably over the past decade, although cholesterol levels remain high in many patients, according to research in this week's BMJ.
Researchers in Scotland identified a random sample of 100 coronary artery bypass patients each year from 1988 to 1997. Questionnaires were sent to their general practitioners to determine what measures were being taken to manage each patient's risk factors such as smoking status, blood pressure and cholesterol concentration.
In general, the standard of preventative care was good for well-established risk factors. For instance, virtually all patients were taking aspirin, had good blood pressure control and only 10% still smoked, following their operation. However, the authors found that patients' cholesterol was often not well managed, particularly in those patients who had bypass surgery before studies showing the benefit of reducing cholesterol were made public. "We believe we have identified a partly forgotten population" say the authors. "Patients who had surgery before these important trials may not be easily identified on GP's disease registers and so are less likely to be receiving cholesterol lowering treatment."
To address this problem, Lothian Health has initiated a project to identify these patients and ensure they are assessed within general practice. "This project is a positive step towards improving the management of cholesterol in many patients with coronary heart disease" conclude the authors.
Contact (available until Thursday 29 June only): Peter Bloomfield, Consultant Cardiologist, Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW Email:PSBloomfield@compuserve.com