Re: “The Enhancing Secondary Prevention in Coronary Artery Disease trial.” 1 As a family physician, two possible explanations come to mind for these surprisingly ‘negative’ results. First, since the patients had elective catheterizations, the primary-care providers may have assumed ongoing follow-up with a cardiologist. Second, with over 80% on a statin, it is possible that these patients had other comorbidities judged to be of higher priority than reaching a maximal statin dose. I agree with the authors that simple interventions are worth testing and I wonder if the team may have benefited from adding a qualitative component to this intervention. This may have allowed the team to identify barriers to prescribing for coronary artery disease and to potentially adjust the intervention accordingly. The result could have been a perception that the intervention was ‘from the ground up,’ leading to greater buy-in. Another option may be to conduct interviews with the participating physicians to learn more about why it did not work as expected.
Footnotes
-
For the full letter, go to: www.cmaj.ca/cgi/eletters/181/12/897#259747
REFERENCE
- 1.↵