Evaluation of a postdischarge coronary artery disease management program

Abstract

Objectives We conducted a demonstration project to assess the value of a nurse practitioner (NP) based coronary artery disease management (CAD‐DM) program for patients with an acute coronary syndrome (ACS) or percutaneous coronary intervention. Methods Patients were recruited to attend three 1‐h monthly visits. The intervention included assessment of clinical symptoms and guideline‐based treatments; education regarding CAD/ACS; review of nutrition, exercise, and appropriate referrals; and recognition of significant symptoms and emergency response. Results Two hundred thirteen (84.5%) completed the program. Physician approval for patient participation was 99%. Average age was 63 ± 11 years, 70% were male, and 89% white. At baseline, 61% (n = 133) had one or more cardiopulmonary symptoms, which declined to 30% at 12 weeks, p < .001. Sixty‐nine percent attended cardiac rehabilitation or an exercise consult. Compared to the initial assessment, an additional 20% were at low‐density lipoprotein cholesterol < 70 mg/dL (p = .04), an additional 35% met exercise goals (p < .0001), and there was an improvement in the mental (baseline 49.7 vs. 12 weeks 53, p = .0015) and physical components (44 vs. 48, p = .002) of the SF‐12 health survey. Conclusion This NP‐based CAD‐DM program was well received and participants demonstrated improvement in physical and mental health, and increased compliance with recommended lifestyle changes.

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC)

“…For this reason, many chronic disease prevention and management (CDPM) programs have been designed with the aim of improving outcomes in these patients. CDPM programs targeting diabetes, [3][4][5][6][7] asthma, 8,9 heart diseases, [10][11][12] depression, [13][14][15] chronic obstructive lung disease (COPD), 16,17 obesity, 18,19 kidney disease, 20 dyslipidemia, 21 hypertension 22 and chronic pain 23 have been shown to be effective in improving outcomes such as hospital admissions, costs, adherence to medication, disease control, use of health services, quality of life and mortality. However, these studies were conducted in different settings and were based on single diseases.…”

“…For this reason, many chronic disease prevention and management (CDPM) programs have been designed with the aim of improving outcomes in these patients. CDPM programs targeting diabetes, 3-7 asthma, 8,9 heart diseases, [10][11][12] costs, adherence to medication, disease control, use of health services, quality of life and mortality. However, these studies were conducted in different settings and were based on single diseases.…”

The role of public health nurses in risk factor modification within a high-risk cardiovascular disease population in Ireland – a qualitative analysis

“…In 2014, the National Directors of Public Health Nursing 23 reiterated the need to develop clinical nurse specialist (CNS) and advanced nurse practitioner (ANP) roles within primary care reform for delivery of chronic disease management programmes. Despite these recommendations plus research evidence indicating the effectiveness of nurse-led multidisciplinary CVD programmes in primary care, 24 this study provides empirical testimony that no such role developments have yet transpired for CVD. The vital role of the nurse in CVD prevention is increasingly endorsed in the literature 25 and also in the recent ESC guidelines.…”

How do nurse practitioners work in primary health care settings? A scoping review

“…These included biometric and biochemical data to measure response to treatment, as well as self-reports of symptom improvement and health related quality of life. For example, individuals with diabetes generally experienced reduced HbA1cs (Chang, Davis et al 2007, Stone, MacPherson et al 2010, Choi and Rush 2012, Jessee and Rutledge 2012 while other individuals reported an improvement in symptoms specific to their disease process (Philp, Lucock et al 2006, Wright, Purdy et al 2007, Owens, Eby et al 2012, Sawatzky, Christie et al 2013, Voorn, Vermeulen et al 2013, Housholder-Hughes, Ranella et al 2015, Kozlowski, Lusk et al 2015, Teunissen, Stegeman et al 2015. In some studies caregivers also benefitted from the nurse practitioner intervention, such as caregivers of patients with dementia who reported a reduced caregiver burden (Ament, Wolfs et al 2015).…”