Implementing national guidance on prevention of coronary heart disease: clinical governance and computer simulation modelling

Standing Medical Advisory Committee (SMAC) guidance for prevention of coronary heart disease (CHD) and the National Service Framework – Coronary Heart Disease both require the identification of patients at high risk of CHD for targeted treatment with statins. Since the best method of identifying these patients is unknown, we compared population screening with opportunistic case finding in a discrete event computer simulation model of the population aged 45‐64 in one local health group in Wales. The main outcome measures were numbers of CHD and all‐cause deaths and extra patient‐years of drug treatment. Screening and case finding were of similar effectiveness in identifying high risk individuals to prevent CHD and all‐cause mortality during the five years simulated. The extra patient‐years of drug treatment required by a population screening programme suggests that screening would not be cost effective. Concludes that opportunistic case finding is the method of choice in primary care.