• coronary heart disease;
  • nurse-led clinics;
  • secondary prevention

• A significant proportion of patients with established ischaemic heart disease remain unrecognized in general practice and those who are receiving treatment are experiencing sub-optimal care.

• The provision of coronary prevention by practice nurses may be an important strategy to improve the quality of this care, and this is feasible and effective.

• This study explored what occurred during patients’ initial assessment for secondary prevention of ischaemic heart disease with a practice nurse and investigated patients’ and practice nurses’ views of nurse-led clinics in primary care.

• Nurses were effective in history taking and offering reassurance and dietary advice, yet were less confident in discussing patients’ understandings of heart disease and related medication.

• Practice nurse-led coronary preventive care is acceptable to both nurses and patients.

• Further practice nurse education is required in heart disease, cardiac medications and skills necessary for exploring and challenging patients’ understandings of these issues.