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Khalid K, Padda J, Ismail D, Abdullah M, Gupta D, Pradeep R, Hameed W, Cooper AC, Jean-Charles G. Correlation of Coronary Artery Disease and Left Ventricular Hypertrophy. Cureus 2021; 13:e17550. [PMID: 34646607 PMCID: PMC8479854 DOI: 10.7759/cureus.17550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 12/23/2022] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of death worldwide, and it is defined as an imbalance between myocardial oxygen supply and demand. Coronary artery disease (CAD) and left ventricular hypertrophy (LVH) are two common causes of IHD that independently result in myocardial ischemia. CAD decreases myocardial blood and oxygen supply whereas LVH increases myocardial oxygen demand. The coexistence of both CAD and LVH results in a significant increase in oxygen demand while simultaneously lowering oxygen supply. Since hypertension is a shared predisposing condition for both CAD and LVH, the left ventricular (LV) mass on noninvasive echocardiography can reflect on the severity of coronary artery stenosis. In clinical practice, it can help physicians decide whether to perform invasive cardiac catheterization to visualize the extent of the coronary block. Although, both CAD and LVH are directly proportional to mortality risk, the addition of eccentric LVH can further increase morbidity and mortality due to myocardial infarction. Therefore, the latest management of both the acute and chronic phases of CAD places an increased emphasis on controlling the predisposing factors to prevent or reverse LVH. For example, angiotensin-converting enzyme inhibitors and diuretics reduce LV mass by lowering the cardiac preload and afterload. This article aims to investigate the deleterious effects of the collaboration between CAD and LVH, establish a causal relationship, and explore the new prevention and management strategies.
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Affiliation(s)
- Khizer Khalid
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Jaskamal Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Dina Ismail
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Dhriti Gupta
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Roshini Pradeep
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Warda Hameed
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, AdventHealth & Orlando Health Hospital, Orlando, USA
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Ögmundsdottir Michelsen H, Nilsson M, Scherstén F, Sjölin I, Schiopu A, Leosdottir M. Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study. BMC Cardiovasc Disord 2018; 18:167. [PMID: 30111283 PMCID: PMC6094912 DOI: 10.1186/s12872-018-0907-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/09/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. METHOD This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. RESULTS Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). CONCLUSION A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.
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Affiliation(s)
- Halldora Ögmundsdottir Michelsen
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Marie Nilsson
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Fredrik Scherstén
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Ingela Sjölin
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Alexandru Schiopu
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Margret Leosdottir
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
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La Sala R, Dicembrino RB, Dall'Argine S, Baiguera M, Gazzotti L, Gubin E, Rondini A, Mamei I. Nurse training in self-management of patients with cardiovascular diseases: a multicentre observational study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:22-30. [PMID: 29189702 PMCID: PMC6357581 DOI: 10.23750/abm.v88i5-s.6882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM The therapeutic education and self-management carried out by nurses, are winning elements in cardiovascular secondary prevention, but because they are complex matters, they require special training by the professionals. The target of the study has been to assess the effects in clinical practice of a training program for nurses in the management of patients with cardiovascular diseases, leaning towards a self-oriented patient management and therapeutic patient education. METHOD The research utilized a quali-quantitative study to compare the responses of 53 trained nurses (experimental group) and 101 untrained nurses (control group). The instrument used was a self-report structured in two sections: the first, a qualitative kind, was used to investigate the portrayal of nurses regarding self-management; the second, a quantitative kind, included a Likert scale based on 5 points (1=never, 5=always) that investigated the professional nurse's action in its bio-psycho-socio-relational and clinical activities (La Sala, 2012). RESULTS The trained nurses' approach is more oriented towards the psycho-socio-relational dimension, compared to the untrained nurses. A difference also emerged regarding activities of a bio clinical nature, which are performed much more by untrained nurses compared to trained professionals. CONCLUSIONS The health education and self-management skills were used by trained nurses during their care of patients with cardiovascular diseases, stressing the importance for professional nurses to develop an integrated competence, using narrative talks as the main tool in a patient-centred approach.
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Snaterse M, Jorstad HT, Heiligenberg M, ter Riet G, Boekholdt SM, Scholte op Reimer W, Peters RJ. Nurse-coordinated care improves the achievement of LDL cholesterol targets through more intensive medication titration. Open Heart 2017; 4:e000607. [PMID: 28761680 PMCID: PMC5515131 DOI: 10.1136/openhrt-2017-000607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/17/2017] [Accepted: 06/13/2017] [Indexed: 12/24/2022] Open
Abstract
Background Nurse-coordinated care (NCC) improves the achievement of low-density lipoprotein-cholesterol (LDL-C) targets after an acute coronary syndrome (ACS). We hypothesised that NCC improves achievement of LDL-C targets through more intensive medication titration. Methods We used data from Randomised Evaluation of Secondary Prevention by Outpatient Nurse Specialists (RESPONSE), a multicentre randomised trial on the efficacy of NCC in 754 ACS patients. Follow-up data were collected at 6 and 12 months. To enable comparison between the various types and dosages of statins, we used the average lipid-lowering potency (ALLP, % LDL-C lowering) as an indicator of lipid-lowering medication intensity. Results Most patients in NCC intervention and usual care groups (96%) had started lipid-lowering therapy during the index hospitalisation. At 6 months, titration activities (up or down) were applied in 45% of NCC patients compared with 24% of patients receiving usual care (p<0.001), and a difference was also seen at 12 months follow-up (52% vs 34%, p<0.001). In patients not on LDL-C target at baseline, titration activities at 6 months were recorded in 63% and 30% of NCC and usual care patients respectively (p<0.001), with increased titration activities in both groups at 12 months (69% vs 43%, p<0.001). Conclusion NCC is associated with more frequent and intense lipid-lowering medication titration to reach LDL-C targets as compared with usual care alone. Further, merely starting the guideline-recommended dose is insufficient to reach the guideline-recommended LDL-C target level. Trial Registration number TC1290 (Netherlands).
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Affiliation(s)
- Marjolein Snaterse
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Harald T Jorstad
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marlies Heiligenberg
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Wilma Scholte op Reimer
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ron J Peters
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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van Schaik TM, Jørstad HT, Twickler TB, Peters RJG, Tijssen JPG, Essink-Bot ML, Fransen MP. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy. Neth Heart J 2017; 25:446-454. [PMID: 28247247 PMCID: PMC5513995 DOI: 10.1007/s12471-017-0963-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To explore the association between health literacy and the risk of cardiovascular disease (CVD), and to assess the differential effects by health literacy level of a nurse-coordinated secondary prevention program (NCPP) in patients with coronary artery disease (CAD). METHODS Data were collected in two medical centres participating in the RESPONSE trial (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists). CVD risk profiles were assessed at baseline and 12-month follow-up using the Systematic Coronary Risk Evaluation (SCORE). Health literacy was assessed by the short Rapid Estimate of Adult Literacy in Medicine (REALM-D) and the Newest Vital Sign (NVS-D); self-reported health literacy was evaluated by the Set of Brief Screening Questions (SBSQ-D). RESULTS Among 201 CAD patients, 18% exhibited reading difficulties, 52% had difficulty understanding and applying written information, and 5% scored low on self-reported health literacy. Patients with low NVS-D scores had a higher CVD risk [mean SCORE 5.2 (SD 4.8) versus 3.3 (SD 4.1), p < 0.01]. Nurse-coordinated care seemed to reduce CVD risk irrespective of health literacy levels without significant differences. CONCLUSION Inadequate health literacy is prevalent in CAD patients in the Netherlands, and is associated with less favourable CVD risk profiles. Where many other forms of CVD prevention fail, nurse-coordinated care seems to be effective among patients with inadequate health literacy.
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Affiliation(s)
- T M van Schaik
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - T B Twickler
- Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital, Antwerp, Belgium.,Department of Endocrinology, Diabetology and Metabolic Diseases, AZ Monica Hospital, Deurne/Antwerp, Belgium
| | - R J G Peters
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P G Tijssen
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M L Essink-Bot
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Fransen
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Jørstad HT, Minneboo M, Helmes HJM, Fagel ND, Scholte Op Reimer WJ, Tijssen JGP, Peters RJG. Effects of a nurse-coordinated prevention programme on health-related quality of life and depression in patients with an acute coronary syndrome: results from the RESPONSE randomised controlled trial. BMC Cardiovasc Disord 2016; 16:144. [PMID: 27391321 PMCID: PMC4938968 DOI: 10.1186/s12872-016-0321-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/10/2016] [Indexed: 12/14/2022] Open
Abstract
Background Improvement of health-related quality of life (HRQOL) is an important goal in preventive cardiology. HRQOL is also related to depressive symptoms, which represent a common co-morbidity and risk factor in patients with an acute coronary syndrome (ACS). Comprehensive nurse-coordinated prevention programmes (NCPP) in secondary care have been shown to reduce cardiovascular risk, however their effects on HRQOL and depressive symptoms have not been evaluated. We therefore investigated HRQOL and depressive symptoms in a secondary analysis in the RESPONSE trial, evaluating the effect of a NCPP on cardiovascular risk. Methods RESPONSE was a multicentre (n = 11) randomised controlled trial in ACS-patients in secondary and tertiary healthcare settings evaluating a NCPP. The intervention consisted of four outpatient nurse clinic visits in the first 6 months after the index event, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care. The control group received usual care only. The outcome was change in HRQOL as measured by the MacNew questionnaire and change in depressive symptoms as measured by Beck’s Depression Inventory (BDI) questionnaire at 12-months follow-up relative to baseline. Results Of 754 patients randomised, 615 were analysed for HRQOL; 120 for depressive symptoms. At baseline, HRQOL was 5.17 (SD 1.09) and 5.20 (SD1.04) (scale range 1.0 to 7.0) in the intervention and control group, respectively. At 12 months follow-up, HRQOL increased by 0.57 (SD 0.89) in the intervention group as compared with 0.42 (SD 0.90) in the control group (p = 0.03). This increase was observed across all relevant subscales. The BDI decreased by 1.9 in the intervention group as compared with 0.03 in the control group (p = 0.03) (scale range 1.0 to 63). Conclusion Participation in a NCPP is associated with a modest but statistically significant increase in HRQOL, and a decrease of depressive symptoms, both of which are highly relevant to patients. A reduction in depressive symptoms may in addition contribute to a reduction in the overall risk of recurrent events. Trial registration Dutch trials register: NTR1290. Registered 24 April 2008.
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Affiliation(s)
- Harald T Jørstad
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Madelon Minneboo
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Harold J M Helmes
- Department of Cardiology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Nick D Fagel
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Jorstad H, Chan Y, Scholte op Reimer W, Doornenbal J, Tijssen J, Peters R. Nurses' perspectives on nurse-coordinated prevention programmes in secondary prevention of cardiovascular disease: a pilot survey. Contemp Nurse 2015; 51:96-106. [PMID: 26572788 PMCID: PMC4784499 DOI: 10.1080/10376178.2015.1119032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secondary prevention of coronary artery disease (CAD) is increasingly provided by nurse-coordinated prevention programs (NCPP). Little is known about nurses' perspectives on these programs. AIM To investigate nurses' perspectives/experiences in NCPPs in acute coronary syndrome patients. METHODS Thirteen nurses from NCPPs in 11 medical centers in the RESPONSE trial completed an online survey containing 45 items evaluating 3 outcome categories: (1) conducting NCPP visits; (2) effects of NCPP interventions on risk profiles and (3) process of care. RESULTS Nurses felt confident in counseling/motivating patients to reduce CAD risk. Interventions targeting LDL, blood pressure and medication adherence were reported as successful, corresponding with significant improvements of these risk factors. Improving weight, smoking and physical activity was reported as less effective. Screening for anxiety/depression was suggested as an improvement. CONCLUSIONS Nurses acknowledge the importance and effectiveness of NCPPs, and correctly identify which components of the program are the most successful. Our study provides a basis for implementation and quality improvement for NCCPs.
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Affiliation(s)
- H.T. Jorstad
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Meibergdreef 9, 1100 DEAmsterdam, The Netherlands
| | - Y.K. Chan
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Meibergdreef 9, 1100 DEAmsterdam, The Netherlands
| | - W.J.M. Scholte op Reimer
- Amsterdam University of Applied Sciences, Nicolaes Tulphuis, Tafelbergweg 51, 1105 BDAmsterdam, The Netherlands
| | - J. Doornenbal
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Meibergdreef 9, 1100 DEAmsterdam, The Netherlands
| | - J.G.P. Tijssen
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Meibergdreef 9, 1100 DEAmsterdam, The Netherlands
| | - R.J.G. Peters
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Meibergdreef 9, 1100 DEAmsterdam, The Netherlands
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Snaterse M, Scholte Op Reimer WJM, Dobber J, Minneboo M, Ter Riet G, Jorstad HT, Boekholdt SM, Peters RJG. Smoking cessation after an acute coronary syndrome: immediate quitters are successful quitters. Neth Heart J 2015; 23:600-7. [PMID: 26449241 PMCID: PMC4651958 DOI: 10.1007/s12471-015-0755-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) prevention guidelines stress the importance of smoking cessation and recommend intensive follow-up. To guide the development of such cessation support strategies, we analysed the characteristics that are associated with successful smoking cessation after an acute coronary syndrome (ACS). METHODS We used data from the Randomised Evaluation of Secondary Prevention for ACS patients coordinated by Outpatient Nurse SpEcialists (RESPONSE) trial (n = 754). This was designed to quantify the impact of a nurse-coordinated prevention program, focusing on healthy lifestyles, traditional CVD risk factors and medication adherence. For the current analysis we included all smokers (324/754, 43 %). Successful quitters were defined as those who reported abstinence at 1 year of follow-up. RESULTS The majority of successful quitters quit immediately after the ACS event and remained abstinent through 1 year of follow-up, without extra support (128/156, 82 %). Higher education level (33 vs. 15 %, p < 0.01), no history of CVD (87 vs. 74 %, p < 0.01) and being on target for LDL-cholesterol level at 1 year (78 vs. 63 %, p < 0.01) were associated with successful quitting. CONCLUSION The majority of successful quitters at 1 year stopped immediately after their ACS. Patients in this group showed that it was within their own ability to quit, and they did not relapse through 1 year of follow-up. Our study indicates that in a large group of patients who quit immediately after a life-threatening event, no relapse prevention program is needed.
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Affiliation(s)
- M Snaterse
- University of Applied Sciences, Hogeschool van Amsterdam, Amsterdam School of Health Professions, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands.
| | - W J M Scholte Op Reimer
- University of Applied Sciences, Hogeschool van Amsterdam, Amsterdam School of Health Professions, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - J Dobber
- University of Applied Sciences, Hogeschool van Amsterdam, Amsterdam School of Health Professions, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - M Minneboo
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - G Ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - S M Boekholdt
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - R J G Peters
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Jorstad HT, von Birgelen C, Alings AMW, Liem A, van Dantzig JM, Jaarsma W, Lok DJA, Kragten HJA, de Vries K, de Milliano PAR, Withagen AJAM, Scholte Op Reimer WJM, Tijssen JGP, Peters RJG. Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial. Heart 2013; 99:1421-30. [PMID: 23813851 PMCID: PMC3786610 DOI: 10.1136/heartjnl-2013-303989] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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 (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial. Setting Multicentre trial in secondary and tertiary healthcare settings. 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.
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Affiliation(s)
- Harald T Jorstad
- Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, Noord Holland, The Netherlands.
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Approaches for non-invasive assessment of endothelial function: focus on peripheral arterial tonometry. Neth Heart J 2013; 21:214-8. [PMID: 22311175 DOI: 10.1007/s12471-011-0202-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The arterial endothelium is a complex organ that modulates vascular tone by release of various substances to control perfusion. Endothelial function reflects vascular ageing and health. Already at the earliest stages of atherosclerosis the delicate balance between arterial constriction and relaxation is disturbed. Therefore, non-invasive assessment of endothelial function is a means to identify patients at increased cardiovascular risk, even at levels of disease that cannot be identified with classical imaging techniques that depict arterial wall and/or lumen or with functional assessment of ischaemia. Currently, there is an increasing interest in the early recognition of endothelial dysfunction to streamline and optimise preventive therapeutic measures. In this article, several methods for the assessment of endothelial function are briefly reviewed. In particular, we discuss the fast bed-side assessment of endothelial function by the reactive hyperaemia peripheral arterial tonometry (RH-PAT) method.
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Taylor J. The 2010 version of the ESC guidelines for the management of grown-up adult congenital heart disease are discussed by guidelines task force chairman H. Baumgartner. Eur Heart J 2011; 31:2825-6. [PMID: 21123278 DOI: 10.1093/eurheartj/ehq309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Jørstad HT, Alings AMW, Liem AH, von Birgelen C, Tijssen JGP, de Vries CJ, Lok DJA, Kragten JA, Peters RJG. RESPONSE study: Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists: Study design, objectives and expected results. Neth Heart J 2011; 17:322-8. [PMID: 19949473 DOI: 10.1007/bf03086277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background. Patients with coronary artery disease are at high risk of coronary events and death, but effective secondary prevention can reduce this risk. There is a gap between guidelines on secondary prevention and the implementation of these measures, which could potentially be reduced by nurse led prevention clinics (NLPC).Objectives. The aim of the current study is to quantify the impact of NLPC on the risk of cardiovascular events in patients with established coronary artery disease.Methods. A randomised, multicentre clinical trial of NLPC in addition to usual care or usual care alone in post-acute coronary syndrome patients. (Neth Heart J 2009;17:322-8.).
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Affiliation(s)
- H T Jørstad
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
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Fransen MP, Van Schaik TM, Twickler TB, Essink-Bot ML. Applicability of internationally available health literacy measures in the Netherlands. JOURNAL OF HEALTH COMMUNICATION 2011; 16 Suppl 3:134-149. [PMID: 21951248 DOI: 10.1080/10810730.2011.604383] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Health literacy measures for use in clinical-epidemiological research have all been developed outside Europe. In the absence of validated Dutch measures, we evaluated the cross-cultural applicability of the Rapid Estimate of Adult Literacy in Medicine (REALM), the Newest Vital Sign (NVS), the Set of Brief Screening Questions (SBSQ), and the measure of Functional Communicative and Critical Health Literacy (FCCHL). Each measure was translated into Dutch following standardized procedures. We assessed feasibility, internal consistency, and construct validity among patients with coronary artery disease (n = 201) and patients with diabetes type 2 (n = 88). Patients expressed most problems in responding to the NVS-D. They were not familiar with the type of food label and had difficulties calculating in portions instead of grams. The FCCHL-D items seemed too theoretical for many patients. Cronbach's alpha was acceptable for all measures. Correlation patterns between the measures were moderately coherent with a priori hypotheses. All translated measures were able to distinguish between high- and low-educated groups of patients, with the NVS-D performing best. Despite reasonable psychometric properties as demonstrated so far, these measures need to be further developed in order to increase applicability for assessing health literacy in clinical-epidemiological research in the Netherlands.
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Affiliation(s)
- M P Fransen
- Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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