The innovation of specialist nurses in coronary heart disease prevention across 12 practices in a rural County Durham Primary Care Trust (PCT) with a high rate of premature death from heart disease helped the Trust achieve the National Service Frame-work (NSF) for Coronary Heart Disease (CHD) targets and milestones. The introduction of nurse-led CHD clinics at each practice provided a structured follow-up for all patients with CHD to locally agreed guidelines. Audit data collected showed that after 12 months, the service showed an improved management of secondary prevention: more patients had had their cholesterol measured, more had received lipid-lowering medication and more had achieved target cholesterol levels of < 5.0 mmol/L than at baseline. Aspirin prescribing also increased. The PCT has also recently introduced a specialist heart failure nurse to carry out a similar programme and, in addition, has addressed cardiac rehabilitation to provide a home-based service for some patients.