Ischaemic heart disease (IHD) includes patients who have angina and heart attacks. The IHD protocol includes some measurable criteria and some that are less easy to measure. We aim to provide an annual review. A computer template that enters a code in the computer record is used to enter data from this review so the entry of the code gives an indication of the annual review activity. Measurement of blood pressure (BP), recording of smoking, alcohol consumption and weight are also measurable criteria of IHD monitoring. Cholesterol and aspirin use are examined in other audits.
This audit was carried out on in July 2001. There were 293 patients with IHD, 5% of the practice population. Of these:-
112 (38%) had a code for coronary heart disease monitoring in the past year
203 (69%) had a recorded systolic blood pressure in the past year
289 (99%) had their smoking status recorded
243 (83%) had their alcohol consumption recorded
254 (87%) had their weight recorded
The population's details have been further examined to look at BP levels. There were 148 men and 145 women with IHD. Of the 293 there were BP readings available for 292. Although the aim is to get BP below 140/85 the national audit standard has been set at a level of 150/90:-
222/292 (76%) had a systolic reading of <150 mmHg
277/292 (95%) had a diastolic reading of <90 mmHg
Nationally it has been decided to provide audit figures for patients aged 35-74 years in order to give a means of comparison in practices with different population structures. Out of 293 patients with ischaemic heart disease in our practice, 170 were aged 35-74. Of these 170:-
136 (80%) had a systolic BP reading of <150 mmHg
161 (95%) had a diastolic reading of <90 mmHg
Discussion
There remains good deal of work to be done, particularly in reducing systolic
blood pressures. The current figures reflect the difficulty of getting BP down
without overloading patients with drugs but they also reflect the change in guidelines that now give equal importance to dealing with both systolic and diastolic blood pressures and that
reduced the target BP to be achieved.
The current measure of the number of annual reviews taking place does not fully reflect the work that is being done because the templates have not been used on all occasions. As we use the templates more frequently, the figures will more accurately reflect the numbers who are actually being reviewed.