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GP contract allows CHD patients to slip through net, warns study

Third of heart patients missing out on statins

By Eleanor Goodman

As many as a third of patients with coronary heart disease continue to miss out on statins because the GP contract fails to properly incentivise their treatment, a new audit concludes.

Researchers warned the proportion on the drugs remained 'dishearteningly' low because there were no payments for treating patients with normal cholesterol levels.

They called for the quality and outcomes framework to pay GPs for treating all patients at high risk irrespective of cholesterol level – a demand echoed by the Primary Care Cardiovascular Society.

The audit, published as a rapid response letter to the BMJ, found that between 2003 and 2005, only half of patients with CHD and 42 per cent with diabetes were on a statin.

Even after the contract, a third of patients with existing CHD were missing out.

Dr Beck Taylor, specialist registrar in public health at Heart of Birmingham PCT and leader of the audit, said the QOF target to reduce cholesterol below 5mmol/l did not go far enough.

'It is disheartening to find such low levels of prescribing in patients for whom statin therapy may have been of benefit. We need to look at patients we know are at high risk. There's plenty more secondary prevention we could be doing.'

Dr Stewart Findlay, treasurer of the Primary Care Cardiovascular Society, agreed. 'All high-risk people should be on a statin, regardless of their starting cholesterol. We'll continue to lobby for incentives.'

GPs questioned whether there should be general incentive for use of drugs such as statins and aspirin rather than current cholesterol targets.

Dr Leslie Lewis, a GP in Newport, warned on the BMJ website: 'There is a mountain of work measuring, adjusting and checking for side-effects just to meet the bizarre and unevidenced QOF targets.'

A study published in the Annals of Internal Medicine last October claimed there was no evidence that benefit from statins was related to the extent of

cholesterol reduction.

Slipping through the statin net

124 CHD-related deaths from 2003 to 2005 were examined, and data on 72 cases obtained

81 per cent of deaths were in patients with a known diagnosis of hypertension, CHD, diabetes, hyperlipidaemia or chronic kidney disease

41 per cent of patients were not on a statin, including 50 per cent with CHD and 42 per cent with diabetes

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