[Medical surveilance and secondary prevention of coronary heart disease in general practice.]

Prevention, both primary and secondary, is an important part in the daily work of most doc-tors. Family physicians (FP) carry the responsibility of implementing both stages of prevention. Coronary heart disease (CHD) is an example of chronic disease where FP have a responsibility both in treatment and prevention. Recent large double blind clinical trials have confirmed the efficacy of various methods of secondary prevention. However, it seems that these tools are used insufficiently, and there may be opportunities for improvement. The aim of this study, which is a part of a larger inquiry about CHD patients, was to evaluate what kind of surveillance these patients receive by their FP and how secondary prevention is organized and implemented in general.

All CHD patients with residence in Hafnarfjörethur, Garethabaer and Bessastaethahreppur (urban communities with 25,000 inhabitants), were invitated to participate in the study. They received an invitation letter and a request for an informed consent. If they chose to participate they answered a questionnaire about CHD risk factors and their medical treatment. Information about their CHD status was gathered by a review of their records at the respective health center. The patients were divided into four groups on the basis of their history: I. Myocardial infarction (MI), II. coronary artery bypass surgery (CABG), III. percutaneous transiluminal coronary angioplasty (PTCA), IV. angina pectoris (AP). If a patient fulfilled the critera for more than one diagnostic group the CABG group had the highest priority followed by PTCA, MI and finally AP.

Of 533 patients with CHD 402 (75%) participated in the study. Electrocardiogram had been recorded for 225 (56%) of these patients. Information about blood pressure was found for 369 (92%) and the mean systolic blood pressure was 143 mraHg (SD 19.8) and diastolic 82 mmHg (SD 9.5). Of CHD patients 15% were followed solely by their FP, 31% were exclusively followed by other specialists (car-diologists), 23% were followed both by FP and other specialists and 11% were without any medical surveillance. About 15% of the participants smoked, 12% were daily smokers and 56% were ex-smokers. Consultation report from a cardiologist had been sent to the respective FP for 43% of the patients.

These results indicate that there is a number of opportunities to improve medical treat-ment and secondary prevention of CHD in Iceland. Improved organization of medical surveillance with clear definiton of treatment goals and full utilisation of those possibilities that are in the Icelandic health care system for secondary prevention, including improvement in the exchange of informations between those involved in treating CHD.