Chapter one presents an overview of Coronary Heart Disease, Ischaemic Stroke and Secondary Prevention. A definition of disease and recurrent events addressed in this thesis is supplied along with the burden of disease in a local context which is compared to National and International burden of disease figures. Given the focus of this thesis is secondary prevention, modifiable risk factors for CHD and Stroke are identified and discussed in terms of their ability to modify CHD and Stroke if prevented. Proportions of risk factors nationally and internationally are presented to give a picture of the magnitude of the risk associated with CHD and Stroke. Management of risk factors in terms of primary and secondary prevention are presented with an emphasis on available guidelines. Proportions of secondary prevention management at national and international level are presented which highlight a gap in care which gives rise to the aim of this thesis. Chapter two explores in the Hunter region the prevalence of risk factors and secondary prevention care in a sample of patients following discharge from hospital for either a CHD or Stroke event. The chapter concludes that there is room for improvement in this population for risk factor management in patients who have had a prior CVD event. Chapter three describes in detail a randomised controlled trial designed to intervene with patients with existing CVD, the Prevent Another Vascular Event (PAVE) study. The chapter provides evidence of the suitability of using General Practitioners as deliverers of care and outlines the methods used in the factorial design which hypothesized an increase in risk factor management in a patient only group, a GP only group, a GP and patient intervention group compared to a usual care control group. The chapter presents recruitment and baseline risk factor prevalence results which are then compared to National and International study data. Chapter four presents results in relation to the pharmaceutical interventions for risk factors such as high blood pressure, high cholesterol and Atrial Fibrillation. Additionally this chapter discusses the use of Aspirin and advice to take Aspirin as an outcome. Chapter five focuses on the results relevant to behavioural risk factor modification such as advice to increase physical activity, increase smoking cessation and advice to follow a modified fat diet. Finally chapter six presents a summary of the findings and the future directions for research and practice.
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University of Newcastle Research Higher Degree Thesis
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