A secondary analysis of patient outcomes in Heartwatch, the Irish Cardiovascular secondary prevention programme in primary care

Robyn Homeniuk, Fintan Stanley, Joseph Gallagher, Claire Collins

Keywords: secondary prevention, cardiovascular health, patient outcomes, primary care, general practice

Background:
In 2003, Ireland set up a secondary prevention programme for cardiovascular disease that is delivered in general practice – Heartwatch. It was designed using European guidelines on secondary prevention for patients with a history of acute myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention. The programme brought structured risk factor management into the community across 20% of Irish general practices.

Research questions:
After 8 years of structured follow-up visits, do patients meet programme targets? Do some patients achieve more targets than others?

Method:
Data was requested and extracted from the national Heartwatch database. To assess patient outcomes, a continuing care score (CCare score) was developed. A CCare score out of 8 was calculated based on well-known cardiovascular risk factors monitored in Heartwatch.

Results:
More than 5,500 patients had 8 years of follow up data, 77% were male. The median age at registration of this cohort was 65. After 1 year in Heartwatch, 33% of the 8-year cohort had achieved a CCare score of 5, which increased to 40% of patients scoring 6 or better after year 8. Patients who enrolled in Heartwatch sooner after their qualifying event achieved more targets, as did male patients, younger patients, and patients who attended more frequently.

Conclusions:
Some patients, including female and older patients, and risk factors, such as waist circumference, do not improve within the current guidelines for secondary prevention programmes. New research on improving the implementation and organisation of secondary prevention programmes for less-improving populations is needed, preferably with patient and public involvement.

Points for discussion:
What barriers exist for patients in achieving cardiovascular risk factor targets in general practice, and how can we overcome them?

What are new approaches to secondary prevention and chronic disease management can be delivered in primary care?

How can patients be empowered to have more control of their own health?