Related Experiment Video
Updated: Jul 2, 2026
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Secondary prevention of cardiovascular disease in different primary healthcare systems with and without
M E Cupples1, M C Byrne, S M Smith
1Public Health Medicine and Primary Care, Queen's University, Belfast, UK. m.cupples@qub.ac.uk
Insights
Cardiovascular risk management, including blood pressure and cholesterol control, was better in Northern Ireland
Area of Science:
- Cardiovascular disease prevention
- Health services research
- Comparative healthcare systems
Background:
- Secondary prevention of coronary heart disease (CHD) is crucial for improving patient outcomes.
- Healthcare system structures and performance incentives can influence the delivery of cardiovascular risk management.
- Differences in healthcare infrastructure may impact the effectiveness of secondary prevention strategies.
Purpose of the Study:
- To compare baseline cardiovascular risk management between patients from two distinct healthcare systems.
- To identify differences in the management of modifiable cardiovascular risk factors in secondary prevention.
- To explore the association between healthcare system characteristics and patient outcomes.
Main Methods:
- A cross-sectional study involving 903 patients with known CHD from 16 general practices in Northern Ireland (NI) and 32 in the Republic of Ireland (RoI).
- Data collected included blood pressure, cholesterol levels, medication use, lifestyle factors (diet, exercise), and healthcare utilization.
- Practices in NI operated within the UK NHS with strong infrastructure and pay-for-performance, while RoI had a mixed economy and less infrastructure.
Main Results:
- Higher rates of uncontrolled systolic blood pressure (>140 mm Hg) and cholesterol (>5 mmol/l) were observed in RoI participants compared to NI.
- Despite better control of BP and cholesterol in NI, RoI participants reported healthier lifestyles and better quality of life.
- Prescribing patterns differed, with fewer beta-blocker prescriptions in RoI, while statin and aspirin use was high in both systems.
Conclusions:
- Primary healthcare systems with robust infrastructure, computerization, and performance incentives are associated with better blood pressure and cholesterol control in CHD patients.
- These improvements in risk factor control were not linked to healthier lifestyles or enhanced quality of life.
- Further research is needed to understand patient and professional engagement in secondary prevention across different healthcare systems.
Objective:
To compare baseline cardiovascular risk management between people from two different healthcare systems recruited to a research trial of an intervention to optimise secondary prevention.
Design:
Cross-sectional study.
Setting:
16 randomly selected general practices in Northern Ireland (NI) (UK NHS, strong infrastructure, pay-for-performance) and 32 in the Republic of Ireland (RoI) (mixed healthcare economy, less infrastructure, no pay-for-performance).
Patients:
903 (mean age 67.5 years; 69.9% male) randomly selected patients with known coronary heart disease.
Main Outcome Measures:
Blood pressure (BP), cholesterol, medications; validated questionnaires for diet (DINE), exercise (Godin) and quality of life (SF-12); healthcare usage.
Results:
More RoI than NI participants had systolic BP >140 mm Hg (37% vs 28%, p = 0.01) and cholesterol >5 mmol/l (24% vs 17%, p = 0.02). RoI mean systolic BP was higher (139 vs 132 mm Hg). More RoI participants reported a high fibre intake (35% vs 23%), higher levels of physical activity (62% vs 44%) and better physical and mental health (SF-12); they also had more GP (5.6 vs 4.4) and fewer nurse visits (1.6 vs 2.1) in the previous year. Fewer participants in the RoI (55% vs 70%) were prescribed beta blockers. ACE inhibitor prescribing was similar for both groups (41%; 48%); high proportions were prescribed statins (84%; 85%) and aspirin (83%; 77%).
Conclusions:
BP and cholesterol are better controlled among patients in a primary healthcare system with a strong infrastructure supporting computerisation and rewarding measured performance, but this is not associated with healthier lifestyle or better quality of life. Further exploration of differences in professionals' and patients' engagement in secondary prevention in different healthcare systems is needed.
Related Concept Videos
01:30Preventive Healthcare Services
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:26Levels of Health Promotion and Illness Prevention
In primary prevention, actions taken before disease onset prevent the disease from...
01:11Secondary Healthcare System
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:26Traditional Level Of Health Care System
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...