Secondary prevention clinics: improving quality of life and outcome.

General practitioners have been encouraged to target patients with coronary heart disease for secondary prevention, but putting this into practice has proven challenging. However, there is now evidence of the benefits from nurse led clinics in primary care. Randomised trials have shown that such clinics can lead to improvement in both medical and lifestyle components of secondary prevention. This has in turn been associated with improved quality of life and a reduction in mortality. Benefits are conditional on several factors: in particular, risk factors are only reduced if clinic attendance is accompanied by appropriate prescribing, and improvements in risk factors are only sustained if the clinics are continued.