Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial

Abstract

Objective-To evaluate the eVectiveness of a nurse led shared care programme to improve coronary heart disease risk factor levels and general health status and to reduce anxiety and depression in patients awaiting coronary artery bypass grafting (CABG). Design-Randomised controlled trial. Setting-Community, January 1997 to March 1998. Study groups-98 (75 male) consecutive patients were recruited to the study within one month of joining the waiting list for elective CABG at Glasgow Royal Infirmary University NHS Trust. Patients were randomly assigned to usual care (control; n = 49) or a nurse led intervention programme (n = 49). Intervention-A shared care programme consisting of health education and motivational interviews, according to individual need, was carried out monthly. Care was provided in the patients' own homes by the community based cardiac liaison nurse alternating with the general practice nurse at the practice clinic. Outcome measures-Smoking status, obesity, physical activity, anxiety and depression, general health status, and proportion of patients exceeding target values for blood pressure, plasma cholesterol, and alcohol intake. Results-Compared with patients who received usual care, those participating in the nurse led programme were more likely to stop smoking (25% v 2%, p = 0.001) and to reduce obesity (body mass index > 30 kg/m 2 ) (16.3% v 8.1%, p = 0.01). Target systolic blood pressure improved by 19.8% compared with a 10.7% decrease in the control group (p = 0.001) and target diastolic blood pressure improved by 21.5% compared with 10.2% in the control group (p = 0.000). However, there was no significant diVerence between groups in the proportion of patients with cholesterol concentrations exceeding target values. There was a significant improvement in general health status scores across all eight domains of the 36 item short form health survey with changes in diVerence in mean scores between the groups ranging from 8.1 (p = 0.005) to 36.1 (p < 0.000). Levels of anxiety and depression improved (p < 0.000) and there was improvement in time spent being physically active (p < 0.000). Conclusions-This nurse led shared care intervention was shown to be eVective for improving care for patients on the waiting list for CABG. (Heart 2001;86:317-323) Keywords: coronary artery bypass grafting; coronary heart disease risk; nurse led shared care; risk reduction Coronary artery bypass graft (CABG) surgery has been shown to be a highly eVective intervention for the relief of angina, improving quality of life and for some patients prolonging life. [1][2][3][4] There has been a 10-fold increase in CABG surgery procedures in the UK, from approximately 3000 a year in 1977, either as a single procedure or together with another cardiac procedure, to almost 25 000 operations in 1995.5 In Scotland, rates of CABG are among the highest in the UK, at 448 operations per million of the population in 1995. The national guaranteed maximum waiting time is one year with a mean waiting time on National Health ...

Experience of cardiac rehabilitation after coronary artery surgery: effects on health and risk factors

“…The influence of socio-economic status is discussed later. It has previously been suggested that CAD risk factor management could be improved across the primary to secondary care interface as well as between the different professional groups looking after patients undergoing coronary artery bypass grafting [15]. We cannot confirm that this is occurring.…”

Postponed or cancelled heart operations from the patient's perspective

“…In addition to information in writing or by telephone, the patient can be informed at a preadmission clinic. Previous studies showed that preoperative anxiety was reduced in intervention groups of heart patients who had been to a preadmission clinic, compared with control groups who did not attend these clinics (Lindsay et al 1998, McHugh et al 2001. A preadmission clinic could also aim at identifying the patientsÕ mood, in order to be better able to support patients who need help, for instance when their operation is postponed or cancelled.…”

Nurse-led management of hypertension

“…Firstly, although no previous study has reported from the Netherlands there have been reports of similar studies from Scotland, 2,3 and England. 4,5 Three of these demonstrated improvements in blood pressure control with nurse-led interventions, 2,3,5 while the other did not.…”

“…4,5 Three of these demonstrated improvements in blood pressure control with nurse-led interventions, 2,3,5 while the other did not. 4 The authors 1 conclude that their findings support the involvement of practice nurses in cardiovascular risk management.…”