• Julia Hippisley-Cox, Michael Pringle, Ruth Cater, Carol Coupland, and Andy Meal.
• Division of General Practice, Nottingham University, UK. julia.hippisley-cox@nottingham.ac.uk
• Br J Gen Pract. 2005 May 1; 55 (514): 369375369-75.

BackgroundThe National Service Framework for Heart Disease sets national standards and defines service models for coronary heart disease (CHD). Little is known about the impact of this intervention on age inequalities.AimTo determine the changes in the uptake of coronary prevention measures before and after the first year of implementation of the National Service Framework for Coronary Heart Disease, and to compare these changes in uptake of coronary prevention in patients aged 75 years and over with younger patients.Design Of StudyRepeated cross-sectional survey using routinely collected data.SettingSeventeen general practices in 17 primary care groups in the Trent Region.MethodAll registered patients at baseline and follow-up aged >/=35 years were categorised into three groups: those with either coronary heart disease or a history of stroke; those with diabetes or hypertension who were not in in the first group; and the remaining population. Data from electronic records was collected to show differences in the proportions of patients with coronary risk factors recorded in the previous year. Data was also collected about differences in the proportions of patients with adequate disease control measures.ResultsImprovements were demonstrated in the recording of coronary risk factors and of disease control measures. However, compared with patients aged <75 years, older patients were significantly less likely to have a serum cholesterol level recorded at baseline; to be on lipid lowering drugs; to be on beta blockers post myocardial infarction and to have well controlled blood pressure. These differences persisted at follow-up.ConclusionThere have been substantial improvements in both the recording of coronary risk factors and disease control measures following the implementation of the National Service Framework for Coronary Heart Disease. However, there needs to be an effort to strengthen the focus on the care of older patients.

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