Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart disease. Improving Outcomes for Older Adults With Heart Failure: A Randomized Trial Using a Theory‐Guided Nursing Intervention A Randomized Controlled Trial of a Discharge Nursing Intervention to Promote Self-Regulation of Care for Early Discharge Interventional Cardiology Patients The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: A randomized clinical trial Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adults Community-based comprehensive lifestyle programs in patients with coronary artery disease: Objectives, design and expected results of Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 trial (RESPONSE 2). Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial Rational and design of a stepped-wedge cluster randomized trial evaluating quality improvement initiative for reducing cardiovascular events among patients with acute coronary syndromes in resource-constrained hospitals in China. A randomized clinical trial of nursing care for recovery from cardiac surgery. Case-Based Training of Evidence-Based Clinical Practice in Primary Care and Decreased Mortality in Patients With Coronary Heart Disease Cardiac Rehabilitation Enrollment and the Impact of Systematic Nursing Interventions for Postmyocardial Infarction and Stent Patients A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)--design, intervention, and population. Effectiveness of chart prompts to improve physician compliance with the National Cholesterol Education Program guidelines. Evaluation of a nurse practitioner disease management model for chronic heart failure: a multi-site implementation study. Influencing Care in Acute Myocardial Infarction: A Randomized Trial Comparing 2 Types of Intervention Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial
BACKGROUND Coronary heart disease is the major cause of illness and death in Western countries and this is likely to increase as the average age of the population rises . Consumers with established coronary heart disease are at the highest risk of experiencing further coronary events . Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in established coronary heart disease . Improved management of cardiac risk factors by providing education and referrals as required has been suggested as one way of maintaining quality care in patients with established coronary heart disease . There is a need to ascertain whether or not  nurse-led clinics would be an effective adjunct for patients with coronary heart disease to supplement general practitioner advice and care . OBJECTIVES The objective of this review was to present the best available evidence related to nurse-led cardiac clinics . INCLUSION CRITERIA This review considered any r and omised controlled trials that evaluated cardiac nurse-led clinics . In the absence of r and omised controlled trials , other research design s such as non-r and omised controlled trials and before and after studies were considered for inclusion . Participants were adults ( 18 years and older ) with new or existing coronary heart disease . The interventions of interest to the review included education , assessment , consultation , referral and administrative structures . Outcomes measured included adverse event rates , readmissions , admissions , clinical and cost effectiveness , consumer satisfaction and compliance with therapy . RESULTS Based on the search terms used , 80 papers were initially identified and review ed for inclusion ; full reports of 24 of these papers were retrieved . There were no papers included that addressed cost effectiveness or adverse events ; and none addressed the outcome of referrals . A critical appraisal of the 24 remaining papers identified a total of six r and omised controlled trials that met the inclusion criteria . Two studies addressed nurse-led clinics for patients diagnosed with angina , one looked at medication administration and the other looked at educational plans . A further four studies compared secondary preventative care with a nurse-led clinic and general practitioner clinic . One specifically compared usual care versus shared care introduced by nurses for patients awaiting coronary artery bypass grafting . Of the remaining three studies , two have been combined in the results section , as they are an interim report and a final report of the same study . Because of inconsistencies in reporting styles and outcome measurements , meta- analysis could not be performed on all outcomes . However , a narrative summary of each study and comparisons of specific outcomes assessed from within each study has been developed . Although not all outcomes obtained statistical significance , nurse-led clinics were at least as effective as general practitioner clinics for most outcomes . Recommendations The following recommendations are made Newly discharged older adults with heart failure continue to experience frequent hospital readmissions , lower quality of life , and decreased satisfaction with health services .  A theory-guided intervention delivered by home health nurses via the telephone was studied using a r and omized controlled trial to assess its feasibility and inform further studies . Findings generated a profile of older adults with heart failure , utilization by patients and nurses , operational issues , and preliminary data on intended outcomes . Implication s for further study are presented This r and omized controlled trial examined a discharge nursing intervention aim ed at promoting self-regulation of care for early discharge interventional cardiology patients . The purpose of this study was to compare medication adherence , patient satisfaction , use of urgent care , and illness perception in patients with cardiovascular disease undergoing interventional revascularization procedures who receive usual care and those who receive a discharge nursing intervention Background Depression is common in people with coronary heart disease ( CHD ) and associated with worse outcome . This study explored the acceptability and feasibility of procedures for a trial and for an intervention , including its potential costs , to inform a definitive r and omized controlled trial ( RCT ) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression . Methods Multi-centre , outcome assessor-blinded , r and omized parallel group study . CHD patients reporting chest pain and scoring 8 or more on the HADS were r and omized to personalized care ( PC ) or treatment as usual ( TAU ) for 6 months and followed for 1 year . Primary outcome was acceptability and feasibility of procedures ; secondary outcomes included mood , chest pain , functional status , well being and psychological process variables . Result 1001 people from 17 General Practice CHD registers in South London consented to be contacted ; out of 126 who were potentially eligible , 81 ( 35 % female , mean age = 65 SD11 years ) were r and omized .  PC  participants ( n = 41 ) identified wide ranging problems to work on with nurse-case managers . Good acceptability and feasibility was indicated by low attrition ( 9 % ) , high engagement and minimal nurse time used ( mean/SD = 78/19 mins assessment , 125/91 mins telephone follow up ) . Both groups improved on all outcomes . The largest between group difference was in the proportion no longer reporting chest pain  ( PC 37 % vs TAU 18 % ; mixed effects model OR 2.21 95 % CI 0.69 , 7.03 ) . Some evidence was seen that self efficacy ( mean scale increase of 2.5 vs 0.9 ) and illness perceptions ( mean scale increase of 7.8 vs 2.5 ) had improved in PC vs TAU participants at 1 year . PC appeared to be more cost effective up to a QALY threshold of approximately £ 3,000 . Conclusions Trial and intervention procedures appeared to be feasible and acceptable . PC allowed patients to work on unaddressed problems and appears cheaper than TAU . Trial Registration Controlled-Trials.com IS RCT Background : Nurse-led interventions have proven beneficial to reduce estimated cardiovascular risk . Aim : The purpose of this study was to evaluate the effect of systematic , nurse-led individual lifestyle counseling sessions on the reduction of 10-year cardiovascular risk scores in patients with coronary artery disease ( CAD ) . Methods : This was a r and omized clinical trial of CAD patients treated at a tertiary referral hospital . The intervention group received nurse-led guidance by means of five face-to-face sessions and telephone contact over the course of one year , starting three months after hospital discharge . Exercise and dietary goals were set for each patient and monitored at each session . The control group received st and ard medical advice . Patients were stratified by Framingham risk score and compared at the end of the follow-up period . Results : The final sample comprised 74 patients , 38 in the intervention group and 36 in the control group . Mean age was 58±9 years ; 74 % of patients were male . A 1.7 point ( −13.6 % ) reduction in risk score was recorded in the intervention group , vs a 1.2 point increase in risk score ( + 11 % ) in the control group ( p=0.011 ) . Significant between-group differences were detected for weight ( intervention , 78±14 kg at baseline vs 77±14 kg at study end ; control , 78±15 kg vs 79±15 kg ; p=0.04 ) , systolic blood pressure ( intervention , 136±22 mm Hg vs 124±15 mm Hg ; control , 126±15 mm Hg vs 129±16 mm Hg ; p=0.005 ) , and diastolic blood pressure ( intervention , 82±10 mm Hg vs 77±09 mm Hg ; control , 79±09 mm Hg vs 80±10 mm Hg ; p=0.02 ) . Conclusion : Structured and systematic nurse-led lifestyle counseling effectively reduced cardiovascular risk score Background Cardiovascular disease is the leading cause of death for adults in Australia . In recent years there has been a shift in health service delivery from institutional to community‐based care for chronic conditions , including cardiovascular disease . The general practice setting is seen to offer greater flexibility , higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector . It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management . To date , significant descriptive research has been conducted exploring the demographics , roles , educational needs and issues facing practice nurses . However , there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes , clinician satisfaction and cost‐effectiveness . Objectives This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults , as well as those with established cardiovascular disease or known cardiac risk factors . Search Strategy A systematic literature search was performed using Medline ( 1966 ‐ 2005 ) , CINAHL ( 1982 −2005 ) , Cochrane Controlled Trials Register ( Issue 4 , 2005 ) and the Joanna Briggs Institute Evidence Library . In addition , the reference lists of retrieved papers , conference proceedings and the Internet , were scrutinised for additional trials . Selection Criteria This review considered any English language r and omised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors . Interventions conducted by specialist cardiac nurses in general practice were excluded . Outcomes measured included blood pressure , smoking cessation , total cholesterol , exercise , body weight/body mass index and cost‐effectiveness . Results Eighteen trials , reported in 33 papers , were included in the review . Ten trials investigated multifaceted interventions , while the remaining eight trials reported targeted interventions . Of the trials that reported multifaceted interventions , three trials investigated risk reduction in those with established cardiovascular disease , four trials focused on those with known cardiovascular disease risk factors and three trials included the general community . The eight trials which examined the efficacy of targeted interventions focused upon dietary intake ( two trials ) , smoking cessation ( three trials ) , weight reduction ( one trial ) and physical activity ( two trials ) . The effect of both the multifaceted and targeted interventions on patient outcomes was variable . However , both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables . Improvements were demonstrated by most studies in blood pressure , cholesterol level , dietary intake and physical activity . The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions . Conclusions While interventions to reduce cardiovascular disease risk factors have produced variable results , they offer significant potential to assist patients in modifying their personal risk profile and should be developed . The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals . Further well‐ design ed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost‐effectiveness UNLABELLED Patients with coronary artery disease ( CAD ) are at high risk of recurrent events . A healthy lifestyle can significantly reduce this risk . A previous trial , R and omized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists ( RESPONSE ) , demonstrated that nurse-coordinated outpatient clinics improve drug treatment of cardiovascular risk factors . However , lifestyle-related risk factors , including smoking , overweight , and physical inactivity , were common and remained largely unchanged at follow-up in most patients ( 66 % ) . The aim of the current study is to evaluate the impact of 3 community-based lifestyle programs in patients after hospitalization for CAD . We are conducting a multicenter ( n = 15 ) , r and omized trial that will recruit 800 patients to test the efficacy of up to 3 widely available commercial lifestyle programs , aim ed at patients and their partners , on top of usual care . These programs are aim ed at smoking cessation ( Luchtsignaal ( ® ) ) , weight loss ( Weight Watchers ( ® ) ) , and improving physical activity ( Philips DirectLife ( ® ) ) . OUTCOMES The primary outcome at 12months is the proportion of patients in whom at least 1 lifestyle risk factor is improved without deterioration in any of the other 2 , and a relative increase of at least 30 % in this proportion is considered clinical ly relevant OBJECTIVE To evaluate the effectiveness 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 R and omised 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 r and omly 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/m2 ) ( 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 difference 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 difference 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 effective for improving care for patients on the waiting list for CABG BACKGROUND Acute coronary syndromes ( ACSs ) are a major cause of morbidity and mortality , yet effective ACS treatments are frequently underused in clinical practice . R and omized trials including the CPACS-2 study suggest that quality improvement initiatives can increase the use of effective treatments , but whether such programs can impact hard clinical outcomes has never been demonstrated in a well-powered r and omized controlled trial . DESIGN The CPACS-3 study is a stepped-wedge cluster-r and omized trial conducted in 104 remote level 2 hospitals without PCI facilities in China . All hospitalized ACS patients will be recruited consecutively over a 30-month period to an anticipated total study population of more than 25,000 patients . After a 6-month baseline period , hospitals will be r and omized to 1 of 4 groups , and a 6-component quality improvement intervention will be implemented sequentially in each group every 6months . These components include the following : establishment of a quality improvement team , implementation of a clinical pathway , training of physicians and nurses , hospital performance audit and feedback , online technical support , and patient education . All patients will be followed up for 6months postdischarge . The primary outcome will be the incidence of in-hospital major adverse cardiovascular events comprising all-cause mortality , myocardial infa rct ion or reinfa rct ion , and nonfatal stroke . CONCLUSIONS The CPACS-3 study will be the first large r and omized trial with sufficient power to assess the effects of a multifaceted quality of care improvement initiative on hard clinical outcomes , in patients with ACS OBJECTIVE To determine the efficacy of a psychoeducational nursing intervention in patients who receive coronary artery bypass graft and valve repair surgery . DESIGN A cluster-r and omized controlled trial design . SETTING Two hospitals in the western United States -- a large community hospital with an active cardiovascular surgery practice and a health-sciences research center . SUBJECTS 156 patients between 25 and 75 years of age , 125 ( 81.1 % ) men , and 31 ( 19.9 % ) women , all with primary care givers . OUTCOME MEASURES Self-efficacy expectations , activities ( behavior performance ) , quality of life , mood state . INTERVENTION Supplemental in-hospital education followed by telephone contact from discharge to eighth week after discharge . RESULTS Patients in the experimental group reported significantly greater self-efficacy expectations for walking and behavior performance for walking , lifting , climbing stairs , general exertion and , where applicable , for working . CONCLUSION This trial suggests that a low-intensity psychoeducational nursing intervention can promote self-efficacy expectations for walking in recovery and is associated with more self-reported walking and lifting behavior after cardiac surgery PURPOSE We investigated the 10-year mortality rates in a trial that tested a case-based intervention in primary care aim ed at reducing the gap between evidence -based goals and clinical practice in patients with coronary heart disease ( CHD ) . METHODS A prospect i ve r and omized controlled pragmatic trial was undertaken in a primary care setting . New evidence -based guidelines , with intensified lipid-lowering recommendations in CHD , were mailed to all general practitioners in the region and presented at a lecture in 1995 . General practitioners ( n = 54 ) and patients with CHD ( n = 88 ) were assigned according to their primary health care center to 2 balanced groups and r and omly allocated to usual care as a control or to an active intervention . General practitioners in the intervention group participated in repeated case-based training during a 2-year period . Patients whose CHD was treated by specialists ( n = 167 ) served as an internal specialist comparison group . Altogether , 255 consecutive patients were included .  Cox regression analysis was used to detect any survival benefit of the intervention . RESULTS At 10 years , 22 % of the patients in the intervention group had died as compared with 44 % in the control group ( P = .02 ) , with a hazard ratio of 0.45 ( 95 % confidence interval , 0.20–0.95 ) . This difference was mainly due to reduced cardiovascular mortality in the intervention group ( P = .01 ) . In addition , the mortality rate of 22 % in the intervention group was comparable to the rate of 23 % seen in patients treated by a specialist . CONCLUSIONS Use of case-based training to implement evidence -based practice in primary care was associated with decreased mortality at 10 years in patients with CHD A r and omized experimental design was used to determine the most effective intervention for enhancing  cardiac rehabilitation ( CR ) enrollment for postmyocardial infa rct ion and stent patients . The 104 subjects ( 70 males and 34 females ; 23 - 87 years old ) were patients with a discharge diagnosis of a myocardial infa rct ion followed by a percutaneous coronary intervention , which included a percutaneous transluminal coronary angioplasty and the placement of one or more coronary stents .  Regardless of the intervention , patients who received face-to-face nursing interventions were more likely to enroll in CR than were patients who had indirect interventions , χ2(3 ) = 32.84 , p < .001 . Patients who experienced an entrance interview were most likely to enroll , χ2(1 ) = 86.80 , p < .001 . Direct logistic regression determined that the full model was statistically significant for all predictors , χ2(5 ) , 105.56 , p < .001 , with the strongest predictor , the entrance interview , having an odds ratio of 1.73 BACKGROUND Current guidelines broadly recommend comprehensive cardiac rehabilitation ( CR ) , although evidence for this is still limited . It is not known whether evidence from before 1995 is still valid . STUDY DESIGN The DANish Cardiac ReHABilitation ( DANREHAB ) trial was design ed as a central ly r and omized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure , ischemic heart disease , or high risk for ischemic heart disease . A combined primary outcome measure included total mortality , myocardial infa rct ion , or readmissions due to heart disease based on linkage to public registries . The CR was an individually tailored , multidisciplinary program ( 6 weeks of intensive CR and 12 months of follow-up ) including patient education , exercise training , dietary counseling , smoking cessation , psychosocial support , risk factor management , and clinical assessment . STUDY POPULATION Of 5060 discharged patients , 1614 ( 32 % ) were eligible for the trial and 770 patients were r and omized ( 47 % of those eligible ) . Participants were younger ( P < .001 ) and had less comorbidity than non participants ( P < .03 ) . CONCLUSION Our trial shows that a large-scale , central ly r and omized clinical trial on comprehensive CR can be conducted among a broadly defined patient group , but reaching the stipulated number of 1800 patients was difficult . Although the study included relatively many women and older people , elderly patients and patients with high comorbidity were underrepresented , which may influence the external validity A lthough the undertreatment of hypercholesterolemia in patients with coronary heart disease ( CHD ) has been well documented , few studies have demonstrated effective interventions to overcome this problem . We hypothesized that undertreatment did not result from physician ’s lack of agreement with the use of such therapy based on clinical or scientific data , but rather physicians are not in the practice of routinely considering and implementing preventive strategies . We postulated a simple intervention that would identify patients who require preventive treatment and remind physicians to consider such therapy , which could effectively increase the number of patients with CHD who receive appropriate treatment for hypercholesterolemia . The objective of the present study was to examine the ability of chart reminders to improve physician compliance with the National Cholesterol Education Program ( NCEP ) treatment guidelines . • • • This was a r and omized , controlled study , which took place in the Cardiology Clinic at Cook County Hospital , Chicago , Illinois . Cook County Hospital is a large , inner-city teaching hospital that serves as a primary care facility to a mostly African-American patient population . Enrollment took place between July 1999 and November 1999 . Consecutive patients were entered into the study if coronary artery disease could be documented by any 1 of the following criteria : ( 1 ) cardiac catheterization showing a 70 % occlusion of 1 of the major epicardial vessels or a 50 % occlusion of the left main coronary artery ; ( 2 ) hospital admission for myocardial infa rct ion , which included chest pain of 30 minutes in duration along with an increase in cardiac enzymes  , or ( 3 ) a chest pain syndrome compatible with angina along with a noninvasive test that was positive for ischemia or infa rct ion . The intervention group included a consecutive sample of 145 patients with CHD , who were examined by 8 physicians ( 4 cardiology fellows , 4 attending cardiologists ) r and omly chosen to receive the intervention . Participating physicians were not notified about the study . The control group included a consecutive sample of 145 patients with CHD , who were examined by 8 physicians ( 4 cardiology fellows , 4 attending cardiologists ) r and omly chosen to not receive the intervention . Patients charts were review ed by a research assistant before their arrival in the clinic and data were collected regarding patient demographics , medical history , and current medications . A research assistant briefly interviewed patients before their visit with the physician , to confirm and up date information gathered from the chart . Laboratory data were collected using the hospital laboratory information system . Intervention consisted of attaching a reminder to the front of the chart when patients were not being managed in accordance with NCEP guidelines , either by virtue of inappropriate medical therapy or the lack of appropriate cholesterol screening . Reminders were individualized to the given patient , citing the NCEP guidelines and suggesting the specific change in management required to restore compliance with the guidelines . Control group patients received no such reminder . Suggested changes in management included : ( 1 ) in patients with a low-density lipoprotein ( LDL ) cholesterol of 130 mg/dl who were not on therapy , a recommendation was made to begin lipid-lowering therapy ; ( 2 ) in patients with an LDL cholesterol of 100 mg/dl who were on lipid-lowering therapy  , a recommendation was made to increase the dosage of the current agent or to add an additional agent ; and ( 3 ) in patients without a documented fasting lipid panel or in those whose most recent lipid panel was obtained 1 year before their visit , a recommendation was made to obtain a fasting lipid panel . Carbon copies of the laboratory order forms and prescriptions were routinely left in patients ’ charts after their clinic visit . Change in management for all intervention and control group patients was assessed by inspecting the charts following their clinic visit for carbon copies of the laboratory order forms and prescriptions , as well as through review of physicians ’ progress notes . After completion of the study , all 16 physicians received a question naire containing 6 open-ended questions intended to assess their knowledge of the NCEP guidelines and their personal approach to the management of hypercholesterolemia in patients with CHD . Statistical analysis was performed using computer software ( SPSS Inc. , Chicago , Illinois ) . General descriptive statistics and analysis of univariate association between baseline variables and compliance with NCEP guidelines were performed using Student ’s t test for continuous variables and chi-square or FishFrom the Division of Cardiology , Cook County Hospital , Chicago , Illinois ; and Section of Cardiology , Rush-Presbyterian-St . Luke ’s Medical Center , Chicago , Illinois . This study was supported in part by an unrestricted educational grant from the Bristol-Myers Squibb Corporation , New York , New York . Dr. Stamos ’ address is : Evanston Northwestern Healthcare , 2560 Ridge Avenue , Evanston , Illinois 60201 . E-mail : tstamos@ enh.org . Manuscript received April 27 , 2001 ; revised manuscript received and accepted August 23 , 2001 While disease management appears to be effective in selected , small groups of CHF patients from r and omized controlled trials , its effectiveness in a broader CHF patient population is not known . This prospect i ve , quasi-experimental study compared patient outcomes under a nurse practitioner-led disease management model ( intervention group ) with outcomes under usual care ( control group ) in both primary and tertiary medical centers . The study included 969 veterans ( 458 intervention , 511 control ) treated for CHF at six VA medical centers . Intervention patients had significantly fewer ( p<0.05 ) CHF and all-cause admissions at one-year follow-up , and lower mortality at both one- and two-year follow-up . These data provide support for the potential effectiveness of the intervention , and suggest that the evidence from RCTs of disease management models for CHF can be translated into clinical practice , even without the benefits of a selected patient population and dedicated re sources often found in RCTs The purpose of this study was to evaluate performance feedback delivered by on-site presentations compared to mailed feedback on improving acute myocardial infa rct ion ( AMI ) care . We used a r and omized trial including 18 hospitals nested within the Cooperative Cardiovascular Project . Patients comprised AMI Medicare patients admitted before ( n = 929 , 1994 and 1995 ) and after intervention ( n = 438 , 1996 ) . Control hospitals received written feedback by mail . The experimental intervention group received a presentation led by a cardiologist and a quality improvement specialist . We assessed the proportion of patients receiving appropriate AMI care before and after the intervention . Both univariate and multivariate analyses demonstrated no effect of the intervention in increasing the proportion of patients who received reperfusion , aspirin , beta-blockers , or angiotensin-converting enzyme in- hibitors . On-site feedback presentations were not associated with a larger improvement in AMI care compared to the mailed feedback . Other interventions , such as opinion leaders and patient-directed interventions , may be necessary in order to improve the care of AMI patients Objective To quantify the impact of a practical , hospital-based nurse-coordinated prevention programme on cardiovascular risk , integrated into the routine clinical care of patients discharged after an acute coronary syndrome , as compared with usual care only . Design RESPONSE ( R and omised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists ) was a r and omised clinical trial . Setting Multicentre trial in secondary and tertiary healthcare setting s. Participants 754 patients admitted for acute coronary syndrome . Intervention A nurse-coordinated prevention programme , consisting of four outpatient nurse clinic visits , focusing on healthy lifestyles , biometric risk factors and medication adherence , in addition to usual care . Main outcome measures The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months follow-up . Secondary outcomes included Framingham Coronary Risk Score at 12 months , in addition to changes in individual risk factors . Risk factor control was classified as ‘ poor ’ if 0 to 3 factors were on target , ‘ fair ’ if 4 to 6 factors were on target , and ‘ good ’ if 7 to 9 were on target . Results The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent ( SD 4.5 ) in the intervention group and 5.4 per cent ( SD 6.2 ) in the control group ( p=0.021 ) , representing a 17.4 % relative risk reduction . At 12 months , risk factor control classified as ‘ good ’ was achieved in 35 % of patients in the intervention group compared with 25 % in the control group ( p=0.003 ) . Attendance to the nurse-coordinated prevention programme was 92 % . In the intervention group , 86 rehospitalisations were observed against 132 in the control group ( relative risk reduction 34.8 % , p=0.023 ) . Conclusions The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical , yet effective method for reduction of cardiovascular risk in patients with coronary disease . Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions . Trial Registration trialregister.nl Identifier TC1290
However , there were no consistent relationships observed between intervention characteristics and the effects of interventions .
Most trials review ed demonstrated a beneficial impact of nursing interventions for secondary prevention in patients with CAD or heart failure .
OBJECTIVE This systematic review of recent r and omized trials was conducted to determine if cardiovascular nursing interventions improve outcomes in patients with coronary artery disease ( CAD ) and /or heart failure .