EVIDENCE BASED PUBLIC HELATH POLICY AND PRACTICE

Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease

I Gemmell¹, R F Heller¹, P McElduff¹, K Payne², G Butler¹, R Edwards¹, M Roland³ and P Durrington⁴

¹ Evidence for Public Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
² North West Genetics Knowledge Park, University of Manchester
³ National Primary Care Research and Development Centre, University of Manchester
⁴ Division of Cardiovascular and Endocrine Science, Department of Medicine, Manchester Royal Infirmary

Correspondence to:
Correspondence to:
Dr I Gemmell
Evidence for Public Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PT, UK; islay.gemmell{at}man.ac.uk

Study objective: To assess the potential number of lives saved associated with the full implementation of aspects of the National Service Framework (NSF) for coronary heart disease (CHD) in England using recently developed population impact measures.

Design: Modelling study.

Setting: Primary care.

Data sources: Published data on prevalence of acute myocardial infarction and heart failure, baseline risk of mortality, the relative risk reduction associated with different interventions and the proportion treated, eligible for treatment and adhering to each intervention.

Main results: Adopting the NSF recommendations for pharmacological interventions would prevent an extra 1027 (95% CI 418 to 1994) deaths in post-acute myocardial infarction (AMI) patients and an extra 37 899 (95% CI 25 690 to 52 503) deaths in heart failure patients in the first year after diagnosis. Lifestyle based interventions would prevent an extra 848 (95% CI 71 to 1 614) deaths in post-AMI patients and an extra 7249 (95% CI 995 to 16 696) deaths in heart failure patients.

Conclusions: Moving from current to "best" practice as recommended in the NSF will have a much greater impact on one year mortality rates among heart failure patients compared with post-AMI patients. Meeting pharmacological based recommendations for heart failure patients will prevent more deaths than meeting lifestyle based recommendations. Population impact numbers can help communicate the impact on a population of the implementation of guidelines and, when created using local data, could help policy makers assess the local impact of implementing a range of health care targets.

Abbreviations: AMI, acute myocardial infarction; NSF, National Service Framework; CHD, coronary heart disease; NEPP, number of events prevented in population; NTP, number to be treated in population; PSSRU, Personal Social Services Research Unit

Keywords: population impact measures; coronary heart disease; national service framework; acute myocardial infarction; heart failure

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