The National Service Framework for Coronary Heart Disease states that the 'second step' in preventing coronary heart disease in the population should aim to identify, advise and treat people without clinical evidence of CHD or other occlusive artery disease but whose risk of a cardiac event is greater than 30% over 10 years. This will necessitate GPs and primary care teams identifying all people at significant risk of cardiovascular disease but who have not yet developed symptoms and offer them appropriate advice and treatment to reduce their risks (Standard 4 of the NSF). To calculate those who may be at a 30% risk, an assessment tool such as the Sheffield risk tables for men or women should be used.

Patients should have a check at 5 yearly intervals. This can be done opportunistically or by invitation.

Aims

  1. To welcome and introduce the patient to the surgery and the services available.
  2. To identify patients health beliefs and enable them to make an informed choice about healthy lifestyle options.
  3. To identify those at greater risk of disease, by ascertaining any family history of diabetes; heart disease; allergies or cancer etc.
  4. To gain baseline measurements of patient's present health status:
    • smoking habits 
    • weight, height - BMI 
    • alcohol consumption 
    • exercise levels 
    • diet 
    • BP (if raised, repeat 2 more times over two weekly intervals - see hypertension protocol) 
    • urinalysis
  5. To identify those patients who might be at increased risk of IHD - if at increased risk, consider offering cholesterol check. However, consider - would a normal cholesterol level lull a smoker with a family history of IHD into a false sense of security, or would finding out what the patient's diet is like and giving advice and reasons why, be more appropriate!
  6. To identify any personal history of significant illness and if necessary take appropriate action (eg if diabetic - enter recall markers)
  7. To check immunisation status and/or smear status.
  8. To identify any allergies that the patient is aware of having.
  9. Enter all details onto the computer. If necessary, arrange any further follow up.