Effectiveness of nurse-delivered cardiovascular risk management in primary care: a randomised trial

Abstract

A substantial part of cardiovascular disease prevention is delivered in primary care. Special attention should be paid to the assessment of cardiovascular risk factors. According to the Dutch guideline for cardiovascular risk management, the heavy workload of cardiovascular risk management for GPs could be shared with advanced practice nurses. AimTo investigate the clinical effectiveness of practice nurses acting as substitutes for GPs in cardiovascular risk management after 1 year of follow-up. Design of studyProspective pragmatic randomised trial. SettingPrimary care in the south of the Netherlands. Six centres (25 GPs, six nurses) participated. MethodA total of 1626 potentially eligible patients at high risk for cardiovascular disease were randomised to a practice nurse group (n = 808) or a GP group (n = 818) in 2006. In total, 701 patients were included in the trial. The Dutch guideline for cardiovascular risk management was used as the protocol, with standardised techniques for risk assessment. Changes in the following risk factors after 1 year were measured: lipids, systolic blood pressure, and body mass index. In addition, patients in the GP group received a brief questionnaire. ResultsA larger decrease in the mean level of risk factors was observed in the practice nurse group compared with the GP group. After controlling for confounders, only the larger decrease in total cholesterol in the practice nurse group was statistically significant (P = 0.01, twosided). ConclusionAdvanced practice nurses are achieving results, equal to or better than GPs for the management of risk factors. The findings of this study support the involvement of practice nurses in cardiovascular risk management in Dutch primary care.

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…550 In 2009, a randomized trial in The Netherlands on CVD risk management and preventive care found that practice nurses achieved results equal to GPs after 1 year of follow-up. 551 A clinical trial (n ¼ 525) in the USA also showed that advanced practice nurses working with community health workers can achieve significant improvements in CV risk factors (BP, cholesterol, DM control) in underserved inner-city populations compared with enhanced usual care, and it was cost-effective. 552 Gap in evidence † Further research is needed in order to explore what is the best strategy to improve implementation of CVD prevention guidelines in general practice, taking into account the heterogeneity among countries in terms of health systems and local resources.…”

Consultation training of nurses for cardiovascular prevention – A randomized study of 2 years duration

“…However, knowledge on how to tailor the treatment so that the individual patient attains sustainable cardioprotective lifestyle behaviour changes is limited. Nurse-managed follow-up visits have turned out to have a positive effect [1,2]. A recent Cochranereview [3] concludes that an organised system with a stepped care approach to antihypertensive drug treatment appears to improve the control of high BP.…”

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