Primary care nursing of coronary patients and reduction of re-infarction risk: a nested case–control study

Objectives. To estimate the risk reduction for re-infarction achieved in primary health care centres. design. This was a case–control study nested in a cohort of coronary patients. tion. Nine hundred and eighty-five coronary patients, aged less than 76 years who had survived for more than 6 months after their first acute myocardial infarction (AMI), were recruited from two public hospitals in Navarre, Spain. Cases (repeated myocardial infarction, n=137) and controls (patients with one AMI who had not had a second infarction, n=137) who had not been treated with invasive procedures were extracted from this cohort and matched by gender, age, hospital and the secondary prevention time frame. es measured. Re-infarction. s. In total, 31.4% of cases and 51.8% of controls attended the primary care nurse clinic regularly. This difference accounted for a significant reduction of the risk of re-infarction, even after adjustment for regular visits to the family physician, life styles (smoking, walking habit and dietary changes) and drug treatments (odds ratio: 0.48; 95% confidence interval: 0.26–0.89). A regular schedule of visits to the family physician showed no association with further coronary risk reduction. sions. Regular attendance of coronary patients at a primary care nurse clinic is associated with a lower risk for re-infarction. Psychological rehabilitation could be the main reason for this benefit, since protection persists after adjustments for other known risk factors.