Cholesterol reduction for the secondary prevention of coronary heart disease: a successful multi‐disciplinary approach to implementing evidence‐based treatment in a district general hospital

The Walsall clinic for survivors of myocardial infarction is described. Coronary heart disease is a major health issue in Walsall. The starting point for the project was the publication of the Scandinavian Simvastatin Survival Study (4S) in 1994, which showed the benefit of cholesterol treatment in these patients. Although the new clinic was established primarily to implement a 4S‐based regime, the cholesterol regime has been modified in the light of newer evidence, and the service broadened to encompass cardiological assessment and the use of other forms of secondary prevention. Several factors have contributed to the success of the service, including support from the Health Authority, patient involvement, partnership with Primary Care and the use of information technology. The latter has integrated routine clinical record keeping and correspondence with complete prospective audit data accumulation and measurement of performance against evidence‐based standards. These principles are of potential value in other clinical effectiveness initiatives.