Objective-To evaluate whether nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease. 1.47, 1.10 to 1.96). There was no eVect on smoking cessation (0.78, 0.47 to 1.28). Of six possible components of secondary prevention, the baseline mean was 3.27. The adjusted mean improvement attributable to intervention was 0.55 of a component (0.44 to 0.67). Improvement was found regardless of practice baseline performance. Conclusions-Nurse run clinics proved practical to implement in general practice and eVectively increased secondary prevention in coronary heart disease. Most patients gained at least one eVective component of secondary prevention and, for them, future cardiovascular events and mortality could be reduced by up to a third.

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Objective: To determine secondary preventive treatment and habits among patients with coronary heart disease in general practice. Design: Process of care data on a random sample of patients were collected from medical records. Health and lifestyle data were collected by postal questionnaire (response rate 71%). Setting: Stratified, random sample of general practices in Grampian.

Within their first year secondary prevention clinics improved patients' health and reduced hospital admissions.

Study objective -Seasonality of coronary heart disease (CHD) was examined to determine whether fatal and non-fatal disease have the same annual rhythm. Design -Time series analysis was carried out on retrospective data over a 10 year period and analysed by age groups (<45 to >75 years) and gender. (under 45 years) admitted to hospital there was a dominant spring peak and an autumn trough. A bimodal pattern of spring and winter peaks was evident for hospital admissions in older male age groups: with increasing age the spring peak diminished and the winter peak increased. In contrast, female hospital admissions showed a dominant winter/summer pattern of seasonal variation. In male and female CHD deaths seasonal variation showed a dominant pattern of winter peaks and summer troughs, with the winter peak spreading into spring in the two youngest male age groups. CHD incidence in women showed a winter/summer rhythm, but in men the spring peak was dominant up to the age of 55. Conclusions -The male, age related spring peak in CHD hospital admissions suggests there is an androgenic risk factor for myocardial infarction operating through an unknown effector mechanism. As age advances and reproduction becomes less important, the well defined winter/summer pattern of seasonal variation in CHD is superimposed, and shows a close relationship with the environment, especially temperature, or the autumn and early winter fall in temperature. (J Epidemiol Community Health 1995;49:575-582) Studies of seasonal variation in coronary heart disease (CHD) are almost entirely based on data derived from national registers of deaths. Studies based on seasonal variation of CHD hospital admissions are few. Dunnigan et all found a bimodal pattern of seasonal variation with spring and winter peaks in a study of 47 281 admissions to all Scottish hospitals in 1962-66 in the diagnostic category ICD 420