Coronary heart disease and the management of risk: Patient perspectives of outcomes associated with the clinical implementation of the National Service Framework targets

This paper explores developments in the risk management of coronary heart disease (CHD) that have followed the implementation of the Coronary Heart Disease National Service Framework (NSF) guidelines from the patient's perspective. The CHD NSF introduced in 2000 set national threshold targets for blood pressure and cholesterol levels for primary care managed patients, it also laid down guidelines for the clinical management of those patients deemed to be at 'high cardiac risk.' Additionally, following the implementation of the revised General Medical Services contract in 2003, financial incentives were introduced to encourage general practitioners to meet these national regulatory guidelines. This paper draws upon the outcomes of a series of focus group discussions with patients with current prescriptions for both hypercholesterolaemia and hypertension carried out in Scotland and South-East England. The findings suggest that many of the patients perceived the regular monitoring of their total serum cholesterol level and subsequent titration of statin therapy as being the primary method by which their heart disease was now to be clinically managed. Patient perceptions of their role in the self-management of their condition were frequently confined to compliance with their monitoring and medication regime. The paper concludes by arguing that, for many of the patients in the study, the implementation of this national cardiac risk management guidance has had the consequence, whether intended or not, of reinforcing a position of medical dependency.