Implementing the evidence: A disease management system for secondary prevention of coronary heart disease in the Scottish Borders.

Scotland has one of the highest rates of coronary heart disease (CHD) in the world. The Hearts in the Borders project was set up in the Scottish Borders with the aim of providing the highest possible standards of care and improving the health of patients with CHD. The project is multidisciplinary and multi-organisational with an innovative implementation strategy involving guideline development and implementation, audit, staff training, and the development and use of a resource pack. The project started in 1998 and three audit cycles (in late 1999, 2000 and 2002) have been conducted to date. All practices in the Borders now have a CHD register. The project targeted patients under the age of 75 years with a history of myocardial infarction, coronary artery bypass grafting and/or angioplasty. Major improvements occurred in cholesterol control with the number of patients with cholesterol below 5 mmol/l improving from 29% to 62%. Aspirin prescribing is high with trends towards better control of blood pressure. Improvements in lifestyle advice given were also found. A positive outcome of the project was a reduction in hospital admissions from 32% in the 1999 audit to 20% in 2002. The project has benefited the Borders by introducing new ways of working across professional and organisational divides, and provided a foundation for the development of a management clinical network for CHD. The model developed has also allowed more rapid planning of a local project to implement the hypertension guidelines. The project has been awarded three national awards for its innovative approach to CHD