Cardiac rehabilitation in the policy targets in UK will only be met with substantial investment to address the barriers identified here.

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Study objective: To investigate the effect of social class and gender on self perceived health status for those recovering from an acute myocardial infarction. Design: A longitudinal survey design was used, collecting both qualitative and quantitative data. Quantitative data are reported in this article, obtained by questionnaire over the first year after the event. SF-36 and EQ-5D (EuroQol) were used to measure self perceived health status. Setting: Community based study in a city in the north of England. Participants: A consecutive sample of 229 people discharged from hospital after acute myocardial infarction. Main results: Overall gain in health status was found to be statistically significant over the year. Improvements were greatest in domains relating to role fulfilment and pursuit of normal and social activities. When analysed by gender, women showed poorer improvement than men, particularly in the domains relating to physical and social functioning. Analysed by social class, those without educational qualifications showed poorer improvement in pain experience and vitality. Access to a car was significant in avoiding physical limitations and promoting general health. Conclusions: Existing gradients between the health of women and men, and between the social classes, are maintained and probably exacerbated by the experience of acute illness, and health professionals need to be made aware of social groups who are at risk of poor rehabilitation. S ocial inequalities in health have been the subject of much research and academic debate over the past 20 years, and more recently have also come to the forefront of UK government thinking about health strategies for the future. The "Saving Lives" white paper 1 expressed concern at widening health inequalities in UK and made tackling ill health among the least advantaged groups a government priority. The Acheson Report 2 acknowledged that gains in length of life over recent decades have not been matched by improvement in life years free of disabling illness, and poorer groups within the population are disproportionately likely to experience limiting long term illness. The incidence of heart attack or acute myocardial infarction (AMI) is strongly related to both gender and social class. 1There is also evidence that women do less well in rehabilitation than men, 5 and are often "invisible" in the literature discussing heart disease.6 Outcomes for survivors of AMI are less satisfactory in areas of deprivation than for those living in more prosperous areas. 7 8 Taking a social model of health, [9][10][11] this research has used health related quality of life (HRQoL) to investigate self perceived health status in survivors of AMI. There is evidence in the literature that age, gender, and social class affect HRQoL in the general population, with women, older people and those from manual occupations reporting poorer HRQoL than men, younger people and those in non-manual occupations. 7 The research question for this study addressed the problem of how pre-existing inequalit...

A home-based self-help rehabilitation package is an effective tool alongside hospital-based rehabilitation classes and can be given to all age groups.

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The many responsibilities of primary care, cardiac rehabilitation and secondary prevention of coronary heart disease is a growing concern. Demanding standards have been given to primary care in the National Service Framework for Coronary Heart Disease. This article reports an evaluation of an intervention to support primary care service providers in this responsibility. A part-time specialist nurse and a part-time exercise worker were appointed to work in a group of 11 GP practices in a primary care trust in a city in the north of England. The evaluation component reported here is a qualitative study of the perceptions of health professionals on secondary prevention of coronary heart disease. Interviews were conducted with 18 primary care staff from practices in both intervention (n = 11) and control (n = 11) groups. The evaluation revealed support for the development of nurse-led clinics, increased confidence and skills development among practice nurses, but some concern about competing demands on practice nurses' time. Primary healthcare professionals found their resources stretched by competing demands on their time from government initiatives.

A low research base and inadequate research utilization are seen as obstacles to acquiring credible professional status for nursing. During recent years there has been some debate, both in Europe and in North America, about the extent to which nurses base their practice on research. This paper reviews recent empirical studies about research utilization, then goes on to describe a small pilot study carried out in the UK to attempt to measure research utilization among general nurses at F/G grade. A large-scale, generalizable survey using similar methods is proposed to build on the knowledge gained from the pilot study. Tentative findings are put forward that show a positive attitude towards research among British clinical nurses. Specialist nurse advisors and research-based protocols are helpful to nurses in accessing research literature. The biggest deterrent to research utilization appears to be lack of perceived autonomy--some nurses feel unable to challenge medical colleagues and organizational managers and so fail to make use of research findings available to them. Significant differences are found between the two hospitals studied in the characteristics of their nursing staff, particularly in relation to their research awareness and degree of perceived autonomy.

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