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Evidence-based secondary prevention of heart disease in primary care - a randomised controlled trial of three methods of implementation

Dates: 1997-2001
Funding: NHS Research & Development programme
Collaborators: Division of Public Health and Primary Health Care, University of Oxford
Information: Alastair Gray

The objective of this study was to evaluate in a randomised controlled trial of 18 general practices three methods of promoting change in primary care: audit and feedback; the introduction of structured records, registers and recall; and the introduction of nurse run clinics. The study focuses on changing the risk factor status and treatment of patients with known ischaemic heart disease.

The framework for the economic evaluation is a cost-effectiveness analysis, in which the net costs and net effectiveness of each intervention are compared. Costs are defined from the perspective of the health care sector, and are based on resource data collected for each patient in the trial. These data include resources associated with each intervention; drugs prescribed; consultations, investigations and referrals; and other hospital and domiciliary care received by patients during the trial. Effectiveness is defined in terms of life-years gained, derived by applying the risk factors prevailing in each group at the final follow-up point of the trial to a Framingham Heart Study risk equation.

The clinical results of this trial were reported in the BMJ in 2001.


Johnston K, Gray AM , Moher M, Yudkin P, Wright L, Mant D. Reporting the Cost-effectiveness of Interventions with Nonsignificant Effect Differences: Example from a Trial of Secondary Prevention of Coronary Heart Disease, International Journal of Technology Assessment in Health Care 2003; 19:3:476-489. Download pdf of article