Læknablaðið - 15.10.1999, Blaðsíða 33

LÆKNABLAÐIÐ 1999; 85
797
Eftirlit og meðferð kransæðasjúklinga
á heilsugæslustöð
Emil L. Sigurðsson' 2, Jón Steinar Jónsson3, Guðmundur Þorgeirsson4
Medical surveilance and secondarv prevention of
coronary heart disease in general practice
Sigurðsson EL, Jónsson JS, Þorgeirsson G
Læknablaðið 1999; 85: 797-804
Objective: Prevention, both printary and secondary,
is an important part in the daily work of most doc-
tors. Family physicians (FP) carry the responsibility
of implementing both stages of prevention. Coronary
heart disease (CHD) is an example of chronic disease
where FP have a responsibility both in treatment and
prevention. Recent large double blind clinical trials
have conftrmed the efficacy of various methods of
secondary prevention. However, it seems that these
tools are used insufficiently, and there may be
opportunities for improvement. The aim of this
study, which is a part of a larger inquiry about CHD
patients, was to evaluate what kind of surveillance
these patients receive by their FP and how secondary
prevention is organized and implemented in general.
Material and methods: All CHD patients with resi-
dence in Hafnarfjörður, Garðabær and Bessastaða-
hreppur (urban communities with 25,000 inhabi-
tants), were invitated to participate in the study. They
received an invitation letter and a request for an
informed consent. If they chose to participate they
answered a questionnaire about CHD risk factors and
their medical treatment. Information about their
CHD status was gathered by a review of their records
at the respective health center. The patients were
divided into four groups on the basis of their history:
Frá 'Heilsugæslustöðinni Sólvangi, Hafnarfirði, 2heimilis-
læknisfræði Háskóla íslands, 3Heilsugæslunni í Garðabæ,
“lyflækningadeild Landspítalans. Fyrirspurnir, bréfaskipti:
Emil L. Sigurðsson, Heilsugæslustöðinni Sólvangi, 220
Hafnarfirði. Sími: 550 2600, netfang: emilsig@solvangur.
hgst.is
Lykilorð: kransæðasjúkdómur, meðferð, forvarnir.
I. Myocardial infarction (MI), II. coronary artery by-
pass surgery (CABG), III. percutaneous transilumi-
nal coronary angioplasty (PTCA), IV. angina pector-
is (AP). If a patient fulfilled the critera for more than
one diagnostic group the CABG group had the high-
est priority followed by PTCA, MI and finally AP.
Results: Of 533 patients with CHD 402 (75%) parti-
cipated in the study. Electrocardiogram had been re-
corded for 225 (56%) of these patients. Information
about blood pressure was found for 369 (92%) and
the mean systolic blood pressure was 143 mmHg
(SD 19.8) and diastolic 82 mmHg (SD 9.5). Of CHD
patients 15% were followed solely by their FP, 31%
were exclusively followed by other specialists (car-
diologists), 23% were followed both by FP and other
specialists and 11% were without any medical sur-
veillance. About 15% of the participants smoked,
12% were daily smokers and 56% were ex-smokers.
Consultation report from a cardiologist had been sent
to the respective FP for 43% of the patients.
Conclusions: These results indicate that there is a
number of opportunities to improve medical treat-
ment and secondary prevention of CHD in Iceland.
Improved organization of medical surveillance with
clear definiton of treatment goals and ful! utilisation
of those possibilities that are in the Icelandic health
care system for secondary prevention, including im-
provement in the exchange of informations between
those involved in treating CHD.
Keywords: coronary heart disease, treatment, prevention.
Ágrip
Tilgangur: Forvarnir, bæði fyrsta og annars
stigs, eru mikilvægur þáttur í starfi flestra
lækna. Heimilislæknar hafa mikilvægu hlut-
verki að gegna í öllu forvarnarstarfi. Krans-
æðasjúkdómur er dæmi um langvinnan sjúk-
dóm þar sem meðal annars heimilislæknar
koma að meðferð og eftirliti. Á síðustu árum
hafa komið fram rannsóknarniðurstöður sem
sýna hversu áhrifaríkar ýmsar aðgerðir í annars