Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis
Cupples, M. E.
Murphy, A. W.
Smith, S. M.
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Murphy, E. Vellinga, A.; Byrne, M.; Cupples, M. E.; Murphy, A. W.; Buckley, B.; Smith, S. M. (2015). Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis. British Journal of General Practice 65 (636), E460-E468
Background Ischaemic heart disease (IHD) is the most common cause of death worldwide. Aim To determine the long-term impact of organisational interventions for secondary prevention of IHD. Design and setting Systematic review and meta-analysis of studies from CENTRAL, MEDLINE (R), Embase, and CINAHL published January 2007 to January 2013. Method Searches were conducted for randomised controlled trials of patients with established IHD, with long-term follow-up, of cardiac secondary prevention programmes targeting organisational change in primary care or community settings. A random effects model was used and risk ratios were calculated. Results Five studies were included with 4005 participants. Meta-analysis of four studies with mortality data at 4.7-6 years showed that organisational interventions were associated with approximately 20% reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79 (95% confidence interval (CI) = 0.66 to 0.93), and a RR for cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies reported mortality data at 10 years. Analysis of these data showed no significant differences between groups. There were insufficient data to conduct a meta-analysis on the effect of interventions on hospital admissions. Additional analyses showed no significant association between organisational interventions and risk factor management or appropriate prescribing at 4.7-6 years. Conclusion Cardiac secondary prevention programmes targeting organisational change are associated with a reduced risk of death for at least 4-6 years. There is insufficient evidence to conclude whether this beneficial effect is maintained indefinitely.