The publication of the Healthwise Database in the British Medical Journal in June 2001 has shown again that in Britain we are poor at implementing well-established strategies which we know reduce the risk of coronary events in patients with ischaemic heart disease. The Healthwise study, which was carried out over 18 months between 1997 and 1998, examined the records of 548 general practitioners (GPs) throughout mainland Britain. The records of 989 161 patients were examined and 24 431 patients with established coronary heart disease (CHD) were identified. The mean age of men was 67 years and women 72 years, and two thirds of the patients were over 70. The middle-aged man with angina has generally been regarded as the typical coronary disease patient. This is not true: it is my view that in the future we will be devoting much of our energies to heart disease in the elderly.
The prevalence of CHD was 2.5% in this survey but it is known that the true prevalence is greater than this. There must be, then, a proportion of patients who are not considered by their general practitioner to have established coronary disease. The Healthwise study addressed one main area: the measures that were being adopted by general practitioners to address risk factors and drug therapy for patients with established coronary heart disease.