Aspects on implementation of coronary heart disease prevention in clinical practice

Prevention of first time disease or recurrence of coronary heart disease (CHD) is a major task for the health service. Guidelines regarding CHD prevention have been issued but studies have shown that treatment goals are inadequately met in clinical practice and there is urgent need for improved methods of implementation of guidelines. There is also a need for better risk stratification tools in order to identify asymptomatic subjects with a high risk for future CHD. This thesis has shown that: A structured, one-year, hospital-based secondary prevention programme after CHD, mainly led by specialist nurses with physician backup, could positively influence the use of lipid-lowering drugs and serum cholesterol levels several years after the end of the programme. A quality control system based on patient empowerment and education with continuous feedback to patients, nurses and physicians seemed to be welcomed by both patients and participating health care professionals. However, our system based on voluntary participation and report cards did not seem to be feasible at this time due to a high dropout rate. Reasons why targets for serum lipids were not met in the EUROASPIRE II study were that too few patients received lipid-lowering drugs, and that of those who did receive such treatment many were treated with sub-optimal doses. Ambulatory ECG with ST-analysis could add significant information on which healthy subjects with a certain accumulation of risk factors who would suffer from a major coronary event (death, AMI or revascularisation) over a 15-year time period