A cardiac prevention and rehabilitation programme for all patients at first presentation with coronary artery disease

Objective--To develop and test a cardiac prevention and rehabilitation programme for achieving sustained lifestyle, risk factor, and therapeutic targets in patients presenting for thr first time with exertional angina, acute coronary syndromes, or coronary revascularisation. Design--A descriptive study. Setting--A hospital based 12 week outpatient programme. Interventions--A multiprofessional family based programme of lifestyle and risk factor modification. Main outcome measures-Non-smoking status, body mass index, blood pressure, plasma cholesterol, use of prophylactic drugs. Results--158 patients (82% of 194 possible cases) were recruited over 15 months, with 72% completing the programme. Targets for achieving non-smoking status, blood pressure < 140/90 mm Hg, and total cholesterol < 4.8 mmol/l were achieved in 92%, 73%, and 62%, respectively, and the proportion on aspirin, <beta> blockers, and lipid lowering treatment was 95%, 58%, and 64% on referral back to general practice for continuing care. Conclusions--A comprehensive cardiac prevention and rehabilitation programme can be offered to all patients presenting for the first time with coronary heart disease, including those with exertional angina who are normally managed in primary care. Lifestyle, risk factor, and therapeutic targets can be successfully achieved in most patients with such a hospital based programme.