Background Implementing preventive measures in patients with established heart disease is one of the most effective health promotion activities, but there is little research on the relationship between cognition and secondary preventive behaviour.Aim To determine the provision of secondary cardiac prevention measures among patients with established heart disease attending a cardiac outpatient clinic.Methods The study was conducted in an outpatient department over a 14-week period in 1999. Management of risk markers was noted from the medical records and lifestyle and psychological variables were self-reported.Results Of 294 patients with heart disease, 41% were available for study. Fourteen per cent were current smokers, one-quarter of males and one-third of females had a body mass index (BMI) greater that 30. Almost 90% attend their GP bimonthly, 67% had a normal systolic and 88.3% a normal diastolic pressure, 34% had normal cholesterol levels and 75% were on aspirin. Lifestyle variables were significantly affected by patient cardiac knowledge, sense of control over their heart disease and perceptions of their illness.Conclusions These results highlight the potential health gain available to patients with established heart disease. The results also suggest that psychological factors may play a role in patients' health behaviours.