1
|
Wei J, Li BWX, Han SJ, Zhuang HJ, Cao WH. Effect of continuous nursing on treatment compliance and side effect management of coronary heart disease. World J Clin Cases 2024; 12:3701-3707. [PMID: 38994285 PMCID: PMC11235468 DOI: 10.12998/wjcc.v12.i19.3701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/12/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND There are relatively few studies on continuing care of coronary heart disease (CHD), and its research value needs to be further clarified. AIM To investigate the effect of continuous nursing on treatment compliance and side effect management in patients with CHD. METHODS This is a retrospective study with patients from January 2021 to 2023. The study was divided into two groups with 30 participants in each group. Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to assess patients' anxiety and depression, and medical coping questionnaire was used to assess patients' coping styles. The pelvic floor dysfunction questionnaire (PFDI-20) was used to assess the status of pelvic floor function, including bladder symptoms, intestinal symptoms, and pelvic symptoms. RESULTS SAS score decreased from 57.33 ± 3.01before treatment to 41.33 ± 3.42 after treatment, SDS score decreased from 50.40 ± 1.45 to 39.47 ± 1.57. The decrease of these two indexes was statistically significant (P < 0.05). PFDI-20 scores decreased from the mean 16.83 ± 1.72 before treatment to 10.47 ± 1.3the mean after treatment, which was statistically significant (P < 0.05). CONCLUSION The results of this study indicate that pioneering research in continuous care of CHD has a positive impact on improving patients' treatment compliance, reducing anxiety and depression levels, and improving coping styles and pelvic floor functional status.
Collapse
Affiliation(s)
- Juan Wei
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Bai-Wen-Xian Li
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Shao-Jie Han
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Hong-Jie Zhuang
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| | - Wen-Hong Cao
- Department of Cardiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 750061, Hebei Province, China
| |
Collapse
|
2
|
Deschodt M, Heeren P, Cerulus M, Duerinckx N, Pape E, van Achterberg T, Vanclooster A, Dauvrin M, Detollenaere J, Van den Heede K, Dobbels F. The effect of consultations performed by specialised nurses or advanced nurse practitioners on patient and organisational outcomes in patients with complex health conditions: An umbrella review. Int J Nurs Stud 2024; 158:104840. [PMID: 38945063 DOI: 10.1016/j.ijnurstu.2024.104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/22/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care. OBJECTIVE This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs). DESIGN Umbrella review. METHODS We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers. RESULTS We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses. CONCLUSIONS The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.
Collapse
Affiliation(s)
- Mieke Deschodt
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Belgium; Competence Center of Nursing, University Hospitals Leuven, Belgium.
| | - Pieter Heeren
- Competence Center of Nursing, University Hospitals Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Marie Cerulus
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Belgium; Competence Center of Nursing, University Hospitals Leuven, Belgium
| | - Nathalie Duerinckx
- Competence Center of Nursing, University Hospitals Leuven, Belgium; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium; Heart Transplant Program, Department of Cardiovascular Diseases, KU Leuven, Belgium
| | - Eva Pape
- Cancer Centre, Ghent University Hospital, Belgium
| | - Theo van Achterberg
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | | | | | | | | | - Fabienne Dobbels
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| |
Collapse
|
3
|
Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 210] [Impact Index Per Article: 210.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
4
|
Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Collapse
|
5
|
Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 180] [Impact Index Per Article: 180.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
Collapse
Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| |
Collapse
|
7
|
Fan W, Guo C, Zhao Q, Ma H. A comprehensive review of the components of nurse-coordinated care which are most effective in preventing coronary heart diseases. Afr Health Sci 2023; 23:528-534. [PMID: 37545913 PMCID: PMC10398472 DOI: 10.4314/ahs.v23i1.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Coronary artery disease occurs when there is inadequate blood flow to the heart muscle as a consequence of coronary artery blockage, resulting in heart muscle failure. During normal heart action, cardiac muscles will always need an adequate supply of blood to fulfill their oxygen requirements. Coronary heart disease is the most common kind of cardiovascular disease in adults and the leading cause of mortality in the United States. Growing understanding of the possible significance of environmental and lifestyle variables in disease development has enhanced the job of the nurse coordinator, whether at a lower or higher level of responsibility, to keep current ondiagnostic procedures, clinical symptoms, and innovative treatment choices. According to the national cardiovascular control program, secondary prevention of cardiovascular disease has increased, including measures such as cholesterol management, blood pressure monitoring, and smoking cessation. If you know more about NCC, it might be easier to figure out what roles it could play and what effects its use might have.
Collapse
Affiliation(s)
- Wenna Fan
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Chao Guo
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Qi Zhao
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Hongbo Ma
- Outpatient pediatrics, The 2 Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| |
Collapse
|
8
|
Taniguchi C, Sezai I, Yoshimi I, Hirano T, Wakao F. Effectiveness of a smoking cessation educational program
for Japanese nurses on subsequent changes of behavior in
delivering smoking cessation counseling. Tob Induc Dis 2022; 20:19. [PMID: 35280046 PMCID: PMC8855205 DOI: 10.18332/tid/144649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Despite the effectiveness of smoking cessation counseling, participation of nurses in delivering smoking cessation advice has been far from satisfactory in practice. Training nurses is considered to be important for increasing self-efficacy and skills for routine delivery of smoking cessation counseling. The aim of the present study was to evaluate the effectiveness of a smoking cessation educational program for Japanese nurses on subsequent changes of their behavior in delivering smoking cessation counseling, three months later. METHODS We ran a 6-hour smoking cessation educational program for nurses recruited from the Nursing Associations of 13 prefectures in Japan between May 2019 and February 2020. Surveys were conducted by questionnaire before the start of the program and 3 months thereafter. The successful implementation of smoking cessation counseling behavior was evaluated according to the 5As of the Clinical Practice Guidelines for Treating Tobacco Use and Dependence (Ask, Advise, Assess, Assist, Arrange). RESULTS We received 289 responses 3 months after the program finished (response rate 46.0%). At that time, 43% of participants had increased the frequency of ‘Ask’ and 42.1%, 50%, 39.3%, and 28.6%, respectively, had also increased their frequency of ‘Advise’, ‘Assess’, ‘Assist’, and ‘Arrange’. We found that smoking cessation counseling was significantly more frequently delivered after the educational program for those participants who had routinely delivered ‘Advise’ before the program as measured by increased delivery of ‘Assess’ and ‘Assist’ afterwards (OR=2.39; 95% CI: 1.00–5.69, OR=2.54; 95% CI: 1.16–5.60 and OR=3.68; 95% CI: 1.40–9.65, OR=2.77; 95% CI: 1.10–7.01, respectively). CONCLUSIONS The program successfully increased the frequency of nurses providing smoking cessation advice to patients. Readiness to deliver smoking cessation counseling before the program and continuing self-efficacy after the program are important for changing the behavior of nurses in delivering smoking cessation counseling.
Collapse
Affiliation(s)
- Chie Taniguchi
- College of Nursing, Aichi Medical University, Nagakute, Japan
- National Cancer Center, Tokyo, Japan
| | - Izumi Sezai
- National Cancer Center, Tokyo, Japan
- Community Health Nursing Section, National Defense Medical College, Tokorozawa, Japan
| | | | | | | |
Collapse
|
9
|
Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
|
10
|
Lifestyle management to prevent atherosclerotic cardiovascular disease: evidence and challenges. Neth Heart J 2021; 30:3-14. [PMID: 34762283 PMCID: PMC8724344 DOI: 10.1007/s12471-021-01642-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 02/07/2023] Open
Abstract
Lifestyle management is the cornerstone of both primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and the importance of lifestyle management is emphasised by all major guidelines. Despite this, actual implementation of lifestyle management is poor. Lifestyle modification includes smoking cessation, weight loss, dietary change, increasing physical inactivity, and stress management. This review summarises evidence-based opportunities and challenges for healthcare professionals to promote healthy lifestyles at an individual level for the prevention of ASCVD.
Collapse
|
11
|
Hsu B, Korda RJ, Lindley RI, Douglas KA, Naganathan V, Jorm LR. Use of health and aged care services in Australia following hospital admission for myocardial infarction, stroke or heart failure. BMC Geriatr 2021; 21:538. [PMID: 34635068 PMCID: PMC8504055 DOI: 10.1186/s12877-021-02519-w] [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] [Received: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services. METHODS The study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006-14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF. RESULTS Two thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18-1.35), 1.53 (95%CI:1.44-1.64) and 1.39 (95%CI:1.32-1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12-1.41), 2.65 (95%CI:2.42-2.91) and 1.50 (95%CI:1.37-1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31-5.32), 3.26 (95%CI:2.91-3.65) and 4.94 (95%CI:4.47-5.46)). CONCLUSIONS Older people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.
Collapse
Affiliation(s)
- Benjumin Hsu
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia. .,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kirsty A Douglas
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Repatriation Hospital and University of Sydney, Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| |
Collapse
|
12
|
Madsen N, Joyce C, Vlasses F, Burkhart L. Effectiveness of an interprofessional ambulatory care model on diabetes: evaluating clinical markers in a low-income patient population. J Interprof Care 2021; 36:500-508. [PMID: 34353211 DOI: 10.1080/13561820.2021.1941816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine whether a new ambulatory care model, interprofessional collaborative care-coordinated team model (interprofessional model), based on the Wagner Care Model improved clinical indicators in a low-income population. This study was a retrospective 12-month pre-post (n = 204) and propensity matched (n = 171) comparative study of the interprofessional model in a primary clinic for patients with type 2 diabetes. Secondary data were collected from June 2014to February 2017 in an academic medical centre in a large Midwestern city. Findings demonstrated statistically and clinically significant improvement in A1C in both the pre/post arm of the study (↓ 0.8%) and the intervention/propensity matched arm (↓ 0.53%). Within the intervention group, there was a significant decrease in weight in the pre/post arm with 55% of cases losing weight, whereas 45% did not lose weight (p = .02). Diastolic blood pressure less than 90 also significantly improved in the pre/post arm of the study (10.1% n = 18, versus 3.9%, n = 7, p = .04). The interprofessional model showed that an ambulatory healthcare redesign incorporating an interprofessional team approach to optimise the health of this type 2 diabetes patient population can be effective. This study demonstrates the importance of using interprofessional collaborative practice teams to guide healthcare and improve patient outcomes.
Collapse
Affiliation(s)
- Nancy Madsen
- School of Nursing/DeKalb, Northern Illinois University, US
| | - Cara Joyce
- Health Informatics and Data Science Parkinson School of Health Sciences and Public Health Maywood, Illinois, US
| | - Frances Vlasses
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US
| | - Lisa Burkhart
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US.,Research Health Scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Junior VA Hospital, Hines, IL, US
| |
Collapse
|
13
|
Irewall AL, Ulvenstam A, Graipe A, Ögren J, Mooe T. Nurse-based secondary preventive follow-up by telephone reduced recurrence of cardiovascular events: a randomised controlled trial. Sci Rep 2021; 11:15628. [PMID: 34341395 PMCID: PMC8329238 DOI: 10.1038/s41598-021-94892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022] Open
Abstract
Enhanced follow-up is needed to improve the results of secondary preventive care in patients with established cardiovascular disease. We examined the effect of long-term, nurse-based, secondary preventive follow-up by telephone on the recurrence of cardiovascular events. Open, randomised, controlled trial with two parallel groups. Between 1 January 2010 and 31 December 2014, consecutive patients (n = 1890) admitted to hospital due to stroke, transient ischaemic attack (TIA), or acute coronary syndrome (ACS) were included. Participants were randomised (1:1) to nurse-based telephone follow-up (intervention, n = 944) or usual care (control, n = 946) and followed until 31 December 2017. The primary endpoint was a composite of stroke, myocardial infarction, cardiac revascularisation, and cardiovascular death. The individual components of the primary endpoint, TIA, and all-cause mortality were analysed as secondary endpoints. The assessment of outcome events was blinded to study group assignment. After a mean follow-up of 4.5 years, 22.7% (n = 214) of patients in the intervention group and 27.1% (n = 256) in the control group reached the primary composite endpoint (HR 0.81, 95% CI 0.68-0.97; ARR 4.4%, 95% CI 0.5-8.3). Secondary endpoints did not differ significantly between groups. Nurse-based secondary preventive follow-up by telephone reduced the recurrence of cardiovascular events during long-term follow-up.
Collapse
Affiliation(s)
- Anna-Lotta Irewall
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
| | - Anders Ulvenstam
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Anna Graipe
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Joachim Ögren
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| |
Collapse
|
14
|
A National Survey Identifying the Factors Associated With Cardiovascular Care Nurses' Perceived Knowledge of International Practice Guidelines: The First Step in the Development of an Implementation Strategy. J Cardiovasc Nurs 2021; 36:E1-E10. [PMID: 33833191 DOI: 10.1097/jcn.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The implementation of international guidelines within everyday practice remains problematic, which can have a detrimental impact on quality of care delivered. This study aimed to ascertain the factors associated with clinical nurses' perceived knowledge of international guidelines. METHODS In this cross-sectional survey, nurses from 45 hospitals across Ireland were recruited. A previously validated anonymous questionnaire that assessed guideline knowledge, use, and barriers to implementation was used. Data were analyzed using SPSS 23 and logistic regression. RESULTS Of the 542 responses, 54% had used international guidelines relevant to their practice and 50% had consulted within the last year. Most nurses perceived that poor patient follow-up, lack of time and resources, poor clinical leadership, workload, long guidelines, and not understanding guideline detail were barriers to guideline use and implementation. Forty-five percent rated their perceived knowledge of guidelines as "low." Logistic regression identified that "high" knowledge levels were significantly associated with having read guidelines in the last year and their use with practice. In contrast, low knowledge of the guidelines was associated with perceptions that they were lengthy and not easy to use, lack of confidence to challenge colleagues when guidelines are not implemented, or not being able to influence current practice. CONCLUSIONS This study identified the specific knowledge needs in this cohort of mainly basic grade registered nurses, with low perceived guideline knowledge. A whole unit or team approach led by nurse champions is needed to develop and establish practice and educational strategies that would increase the availability, application, and knowledge of guidelines within everyday practice.
Collapse
|
15
|
B Ramadhani F, Liu Y, Jing X, Qing Y, Xiong H, Zhang F, Wei P. Comparing the association of cardiovascular nursing care with blood pressure and length of stay of in-patients with coronary artery disease in Wuhan, China. Afr Health Sci 2020; 20:1716-1724. [PMID: 34394231 PMCID: PMC8351856 DOI: 10.4314/ahs.v20i4.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Coronary artery disease is a leading cause of morbidity and mortality worldwide. Comorbidity-like hypertension has been among the major risks of coronary artery disease. Recent evidence identified multiple benefits of cardiovascular nursing care to coronary patients. However, little has been appraised on benefits regarding patients' blood pressure control and length of hospitalisation. Objective To compare the association of cardiovascular nursing care delivered to coronary artery patients with patients' blood pressure and length of stay. Methods Records based retrospective design was applied at a large teaching hospital in Wuhan, China. SPSS 21 version was used for data entry and analysis with univariate and multivariate logistic regression models for comparing study variables. Results Of 300 patients, 224 (74.7%) were known to be hypertensive and admitted with subnormal blood pressure. Cardiovascular nursing care like “assess to grade pain severity on 1–10 scale” and “counsel patient to cope with stress” were six and three times more likely to contribute improved patients' blood pressure (AOR=5.8; 95%CI: 2.8–12.2, p=0.001) and (AOR=3.1; 95%CI: 1.2–7.8, p=0.015) respectively. No significant difference with length of stay (p>0.05). Conclusion There is a possibility of coronary artery patients to recover with normal blood pressure following reception of evidence-based cardiovascular nursing care.
Collapse
|
16
|
Köhler AK, Jaarsma T, Tingström P, Nilsson S. The effect of problem-based learning after coronary heart disease - a randomised study in primary health care (COR-PRIM). BMC Cardiovasc Disord 2020; 20:370. [PMID: 32795267 PMCID: PMC7427729 DOI: 10.1186/s12872-020-01647-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients' empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD. METHODS Patients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age. 68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n = 79) or home-sent patient information (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year. RESULTS At one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [- 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body weight [- 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring the experimental group compared to controls. CONCLUSIONS The problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information. TRIAL REGISTRATION NCT01462799 (February 2020).
Collapse
Affiliation(s)
- Anita Kärner Köhler
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Pia Tingström
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Staffan Nilsson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Primary Health Care Centre in Vikbolandet, 610 24 Vikbolandet, Sweden
| |
Collapse
|
17
|
Laurent J, Le Cossec C, de Chambine S. [Nursing coordination in chronic diseases: The situation of activities in the Assistance Publique-Hôpitaux de Paris adult medicine units]. Rech Soins Infirm 2019:90-98. [PMID: 31210505 DOI: 10.3917/rsi.136.0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The transformation of nurse's profession can be an opportunity for the organization of personalized care pathways for patients with chronic diseases. OBJECTIVE Our objective was to identify and describe the activities of the coordinating nurses (IDEC) working with patients with chronic diseases in adult medicine services at the Assistance Publique - Hôpitaux de Paris (AP-HP). METHOD An e-mail survey of department heads identified the IDEC. Semi-structured interviews were conducted with IDEC and referring physicians in order to know IDEC's activities « in practice ». RESULTS Forty-eight IDEC were identified in 115 adult medicine departments contacted at AP-HP. IDEC mainly engaged in expertise and coordination activities. IDEC help to free up medical time, patients are satisfied to have a dedicated contact to whom to turn in case of problems. DISCUSSION IDEC are involved in many chronic diseases. Their expertise serves primarily patients but also health professionals who intervene in the course of care. This work will feed reflection on the transformation of nursing professions, especially since the recognition of nursing practice in advanced practice.
Collapse
|
18
|
Ramadhani FB, Liu Y, Jing X, Qing Y, Rathnayake AK, Kara WSK, Wu W. Investigating the Relevance of Nursing Caring Interventions Delivered to Patients with Coronary Artery Disease at a Teaching Hospital in China: A Retrospective Study. Cureus 2019; 11:e4672. [PMID: 31328064 PMCID: PMC6634272 DOI: 10.7759/cureus.4672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide. Previous systematic reviews and meta-analysis of randomized controlled trials concluded that nursing caring interventions (NCIs) are beneficial for coronary artery patients. However, most of those interventions were conducted in outpatient or home-based settings or through the telephone. Due to its multiple benefits, the authors recommended the application of such interventions to hospitalized coronary artery patients. Currently, little is known on the status of application of such evidence-based interventions in the actual clinical setting for hospitalized coronary artery patients. Similar studies conducted in China were also inadequate. Therefore, this study aimed to investigate the kinds of NCIs delivered to hospitalized coronary artery patients and their consistent relationship with risk factors of CAD found in the clinical records of patients. Results of this study were expected to alert nurses to consider such risk factors when caring for coronary artery patients as well as appraising their caring efforts in improving the patient's wellbeing for the reduction of morbidity and mortality from a CAD sequel. This report also disseminates some cardiovascular knowledge and health tips to the readers. METHODS A descriptive, cross-sectional, retrospective design using clinical case notes was employed; the study was undertaken in coronary care wards at the teaching hospital in China from November 2017 to September 2018. A total of 300 coronary artery case notes were randomly selected from 700 eligible cardiovascular patients files by using a simple random technique of simple random numbers through Microsoft office excel sheet. Chi-square (χ2) test and multivariate logistic regression analysis for adjusted odds ratio with 95% confidence interval (CI) within its range were used to compare the relationship among independent (patient's demographic and clinical risk factors of CAD) and dependent variables (NCIs implemented to such patients). RESULTS A total of 300 coronary artery patients' case notes were audited with a mean age of 63±11.2 years. Of these 175 (58.3%) were males, 126 (42%) were smokers and 224 (74.7%) were hypertensive. NCIs such as "administer coronary artery medication and their instructions" was mostly delivered to 291 (97%) patients. The delivery of three out of eight gathered NCIs were significantly influenced by three or all of these CAD risk factors (age, smoking, hypertension, and diabetes) (p < 0.05 and/or < 0.01) with an adjusted odds ratio (95% CI) within their significant ranges. Patients with diabetes mellitus were five times more likely to influence the delivery of "administer medication and their instructions" than the rest of patients with coronary artery risk factors (p < 0.01; AOR (95% CI) 5.02(2.059-7.207). CONCLUSION This study reveals that nurses delivered beneficial evidence-based interventions to patients with CAD. The interventions were significantly consistent with age as an unmodifiable risk factor and smoking, hypertension, and diabetes as modifiable risk factors of CAD. However, the management of stress in these patients was low; and since stress may trigger CAD, it should be assessed and managed appropriately.
Collapse
Affiliation(s)
- Fatina B Ramadhani
- Internal Medicine, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Yilan Liu
- Internal Medicine, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Xue Jing
- Cardiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Ye Qing
- Cardiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Ayoma K Rathnayake
- Internal Medicine and Endocrinology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Waheeda Shokat K Kara
- Nursing Psychiatry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Wei Wu
- Intensive Care, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| |
Collapse
|
19
|
Jepma P, Ter Riet G, van Rijn M, Latour CHM, Peters RJG, Scholte Op Reimer WJM, Buurman BM. Readmission and mortality in patients ≥70 years with acute myocardial infarction or heart failure in the Netherlands: a retrospective cohort study of incidences and changes in risk factors over time. Neth Heart J 2019; 27:134-141. [PMID: 30715672 PMCID: PMC6393584 DOI: 10.1007/s12471-019-1227-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives To determine the risk of first unplanned all-cause readmission and mortality of patients ≥70 years with acute myocardial infarction (AMI) or heart failure (HF) and to explore which effects of baseline risk factors vary over time. Methods A retrospective cohort study was performed on hospital and mortality data (2008) from Statistics Netherlands including 5,175 (AMI) and 9,837 (HF) patients. We calculated cumulative weekly incidences for first unplanned all-cause readmission and mortality during 6 months post-discharge and explored patient characteristics associated with these events. Results At 6 months, 20.4% and 9.9% (AMI) and 24.6% and 22.4% (HF) of patients had been readmitted or had died, respectively. The highest incidences were found in week 1. An increased risk for 14-day mortality after AMI was observed in patients who lived alone (hazard ratio (HR) 1.57, 95% confidence interval (CI) 1.01–2.44) and within 30 and 42 days in patients with a Charlson Comorbidity Index ≥3. In HF patients, increased risks for readmissions within 7, 30 and 42 days were found for a Charlson Comorbidity Index ≥3 and within 42 days for patients with an admission in the previous 6 months (HR 1.42, 95% CI 1.12–1.80). Non-native Dutch HF patients had an increased risk of 14-day mortality (HR 1.74, 95% CI 1.09–2.78). Conclusion The risk of unplanned readmission and mortality in older AMI and HF patients was highest in the 1st week post-discharge, and the effect of some risk factors changed over time. Transitional care interventions need to be provided as soon as possible to prevent early readmission and mortality. Electronic supplementary material The online version of this article (10.1007/s12471-019-1227-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- P Jepma
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - G Ter Riet
- Amsterdam UMC, Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Rijn
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - C H M Latour
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - R J G Peters
- Amsterdam UMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - W J M Scholte Op Reimer
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - B M Buurman
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Ögren J, Irewall AL, Söderström L, Mooe T. Long-term, telephone-based follow-up after stroke and TIA improves risk factors: 36-month results from the randomized controlled NAILED stroke risk factor trial. BMC Neurol 2018; 18:153. [PMID: 30241499 PMCID: PMC6148791 DOI: 10.1186/s12883-018-1158-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Background Strategies are needed to improve adherence to the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level recommendations after stroke and transient ischemic attack (TIA). We investigated whether nurse-led, telephone-based follow-up that included medication titration was more efficient than usual care in improving BP and LDL-C levels 36 months after discharge following stroke or TIA. Methods All patients admitted for stroke or TIA at Östersund hospital that could participate in the telephone-based follow-up were considered eligible. Participants were randomized to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C were measured one month after discharge and yearly thereafter. Intervention group patients who did not meet the target values received additional follow-up, including lifestyle counselling and medication titration, to reach their treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L). The primary outcome was the systolic BP level 36 months after discharge. Results Out of 871 randomized patients, 660 completed the 36-month follow-up. The mean systolic and diastolic BP values in the intervention group were 128.1 mmHg (95% CI 125.8–130.5) and 75.3 mmHg (95% CI 73.8–76.9), respectively. This was 6.1 mmHg (95% CI 3.6–8.6, p < 0.001) and 3.4 mmHg (95% CI 1.8–5.1, p < 0.001) lower than in the control group. The mean LDL-C level was 2.2 mmol/L in the intervention group, which was 0.3 mmol/L (95% CI 0.2–0.5, p < 0.001) lower than in controls. A larger proportion of the intervention group reached the treatment goal for BP (systolic: 79.4% vs. 55.3%, p < 0.001; diastolic: 90.3% vs. 77.9%, p < 0.001) as well as for LDL-C (69.3% vs. 48.9%, p < 0.001). Conclusions Compared with usual care, a nurse-led telephone-based intervention that included medication titration after stroke or TIA improved BP and LDL-C levels and increased the proportion of patients that reached the treatment target 36 months after discharge. Trial registration ISRCTN Registry ISRCTN23868518 (retrospectively registered, June 19, 2012). Electronic supplementary material The online version of this article (10.1186/s12883-018-1158-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joachim Ögren
- Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden.
| | - Anna-Lotta Irewall
- Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden
| | - Lars Söderström
- Unit of Research, Development and Education, Östersund, Sweden
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden
| |
Collapse
|
21
|
Paoli G, Notarangelo MF, Mattioli M, La Sala R, Foà C, Solinas E, Fusco S, Fava C, Caminiti C, Artioli G, Pelà G, Dall'Aglio E, Manari A, Tondi S, Rizzo A, Trapolin G, Patrizi G, Cappelli S, Villani GQ, Piepoli M, Zobbi G, Nicosia E, Ardissino D. ALLiance for sEcondary PREvention after an acute coronary syndrome. The ALLEPRE trial: A multicenter fully nurse-coordinated intensive intervention program. Am Heart J 2018; 203:12-16. [PMID: 29966801 DOI: 10.1016/j.ahj.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Abstract
The main objective of cardiovascular disease prevention is to reduce morbidity and mortality by promoting a healthy lifestyle, reducing risk factors, and improving adherence to medications. Secondary prevention after an acute coronary syndrome has proved to be effective in reducing new cardiovascular events, but its limited use in everyday clinical practice suggests that there is considerable room for improvement. The short-term results of evidence-based studies of nurse-coordinated secondary prevention programs have been positive, but there is a lack of long-term outcome data. The Alliance for the Secondary Prevention of Cardiovascular Disease in the Emilia-Romagna region (ALLEPRE) is a multicenter, randomized, controlled trial designed to compare the effects of a structured nurse-coordinated intensive intervention on long-term outcomes and risk profiles after an acute coronary syndrome with those of the standard of care. All of the patients randomized to the intervention group take part in 9 one-to-one sessions with an experienced nurse from the participating centers with the aim at promoting healthy lifestyles, reducing risk factors, and increasing adherence to medication over a mean period of 5 years. The primary clinical end point is the reduction in the risk of the 5-year occurrence of major adverse events (a composite of cardiovascular mortality, nonfatal reinfarction, and nonfatal stroke). The primary surrogate end point is the achievement of prespecified targets relating to classical risk factors, lifestyle modifications, and adherence to pharmacological therapy after 2 years of follow-up.
Coronary heart disease is a chronic degenerative disease, and patients who recover from an acute coronary syndrome (ACS) are at high risk of developing recurrent events.1 Although secondary prevention measures have proved to be effective and are strongly recommended by all of the international guidelines,2., 3. the 4 EUROASPIRE surveys4., 5., 6., 7., 8. showed that there was still a high prevalence of conventional risk factors, that secondary prevention measures were inadequately implemented, and that their main goals were often not reached. In addition, there were considerable discrepancy in secondary prevention practices between centers and countries, and a widespread underuse of cardiac prevention and rehabilitation programs despite their demonstrated effectiveness in reducing cardiovascular risk over time.9., 10.
Over the last 10 years, nurses have been increasingly involved in successful cardiovascular risk management,11., 12., 13. but although this has improved levels of cardiovascular risk, no clear reduction in hard end points such as major cardiovascular adverse events and mortality has been demonstrated.10
The aim of the ALLEPRE trial is to evaluate the benefit of a homogeneous, structured, secondary prevention intervention program, fully coordinated by nurses from in- and outpatient clinics, in terms of cardiovascular risk profiles and major clinical events in ACS patients living in the large Emilia-Romagna region of Italy.
Collapse
Affiliation(s)
- Giorgia Paoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | | | - Maria Mattioli
- Division of Cardiovascular Disease, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rachele La Sala
- Teaching and Training Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Chiara Foà
- Teaching and Training Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Sara Fusco
- Division of Cardiology, Ospedale di Fidenza, Parma, Italy
| | - Cristian Fava
- Division of Cardiology, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Caterina Caminiti
- Research and Innovation Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giovanna Artioli
- Palliative Care Unit, Arcispedale S. Maria Nuova-IRCCS di Reggio-Emilia, Reggio Emilia, Italy
| | - Giovanna Pelà
- Division of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elisabetta Dall'Aglio
- Division of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Manari
- Division of Cardiology, Ospedale Santa Maria Nuova di Castelnovo ne' Monti, Reggio-Emilia, Italy
| | - Stefano Tondi
- Division of Cardiovascular Disease, Nuovo Ospedale Civile Sant'Agostino Estense di Baggiovara, Modena, Italy
| | - Antonio Rizzo
- Division of Cardiology, Ospedale di Fidenza, Parma, Italy
| | - Gaia Trapolin
- Division of Cardiology, Ospedale di Fidenza, Parma, Italy
| | | | - Stefano Cappelli
- Division of Cardiology, Ospedale Ramazzini di Carpi, Modena, Italy
| | | | - Massimo Piepoli
- Division of Cardiology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Gianni Zobbi
- Division of Cardiology, Ospedale Santa Maria Nuova di Castelnovo ne' Monti, Reggio-Emilia, Italy
| | - Elisa Nicosia
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| |
Collapse
|
22
|
Smoking cessation after nurse-coordinated referral to a comprehensive lifestyle programme in patients with coronary artery disease: a substudy of the RESPONSE-2 trial. Eur J Cardiovasc Nurs 2018; 18:113-121. [DOI: 10.1177/1474515118795722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
23
|
Shared decision-making (SHARE-D) for healthy behaviour change: a feasibility study in general practice. BJGP Open 2018; 2:bjgpopen18X101517. [PMID: 30564717 PMCID: PMC6184102 DOI: 10.3399/bjgpopen18x101517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/30/2017] [Indexed: 12/18/2022] Open
Abstract
Background Effective interventions are needed to support health behaviour change for cardiovascular disease (CVD) prevention. Decision tools encourage behaviour change but their effectiveness when used in shared decision-making with health professionals (HPs) is unknown. Aim To test the feasibility of using a novel, paper-based tool for shared decision-making in initiating behaviour change. Design & setting A feasibility study in five general practices in Northern Ireland. Method Adults with, or at high risk of, CVD were invited to discuss their diet and physical activity (PA) with an HP. Using a paper-based decision aid in shared decision-making about behaviour change, their capabilities, opportunities, and motivation were considered. Diet and PA were assessed at baseline, 1, and 3 months using the Dietary Instrument for Nutritional Education (DINE) and the Recent Physical Activity Questionnaire (RPAQ); accelerometers measured PA at baseline and 3 months. Semi-structured interviews, analysed thematically, explored participants’ and HPs’ views of the process. Results The positive response rate to study invitation was 28% (45/162); 23 were recruited (aged 43–74 years; 50% male; <40% met diet or PA recommendations); and 87% (20/23) completed the study. All interviewees valued the tool’s structure, succinct content, and facilitation of discussion. HPs’ sharing of relevant personal experience encouraged behaviour change; social responsibilities, health conditions, and beliefs restricted change. HPs’ workloads prohibited the tool’s routine use. Conclusion Recruitment and completion rates suggest that using a novel, paper-based tool in shared decision-making for behaviour change is feasible. HPs’ workloads constrain its use in practice, but qualitative findings indicate its potential value. Cross-sector collaborative exploration of sustainable models to promote behaviour change is needed.
Collapse
|
24
|
Abstract
Cardiovascular disease accounts for 17,500 deaths globally, representing nearly half of all non-communicable disease deaths. The World Health Organization has set nine lifestyle, risk factor and medicines targets to achieve by 2025 with the aim of reducing premature mortality from non-communicable diseases by 25%. In order to succeed in this, we need to equip our global health professional workforce with the skills to support patients and their families with making lifestyle changes and being in concordance with cardioprotective medication regimes at every opportunity. Success depends on collegiate working through effective interdisciplinary team-based care characterised by shared goals, clear roles, mutual trust, effective communication and measurable processes and outcomes, with the patient and family at the centre of care. Nurses are the largest sector of the health professional workforce and their role in prevention should be optimised. Nurse coordinated care is proven to be effective, especially where they work in an interdisciplinary way with other health professionals such as doctors, pharmacists and psychologists, who provide equally important expertise for supporting holistic care. Successful care models are those that comprehensively target all adverse lifestyles and risk factors that are responsible for the development of cardiovascular disease. These characteristics should be reflected in the standards and core components of prevention and rehabilitation programmes.
Collapse
Affiliation(s)
- Catriona Jennings
- 1 National Heart and Lung Institute, Imperial College London, London, UK
| | - Felicity Astin
- 2 Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
| |
Collapse
|
25
|
Bosworth HB, Ngouyombo B, Liska J, Zullig LL, Atlani C, Beal AC. The importance of cholesterol medication adherence: the need for behavioral change intervention programs. Patient Prefer Adherence 2018; 12:341-348. [PMID: 29563777 PMCID: PMC5846762 DOI: 10.2147/ppa.s153766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lipid-lowering medications have been shown to be efficacious, but adherence is suboptimal. This is a narrative, perspective review of recently published literature in the field of medication adherence research for lipid-lowering medications. We provide an overview of the impact of suboptimal adherence and use a World Health Organization framework (patient, condition, therapy, socioeconomic, and health system-related systems) to discuss factors that influence hyperlipidemia treatment adherence. Further, the review involves an evaluation of intervention strategies to increase hyperlipidemia treatment adherence with a special focus on mHealth interventions, patient reminders on packaging labels, nurse- and pharmacist-led interventions, and health teams. It also highlights opportunities for pharmaceutical companies to support and scale such behavioral interventions. Medication adherence remains a challenge for the long-term management of chronic conditions, especially those involving asymptomatic disease such as hyperlipidemia. To engage patients and enhance motivation over time, hyperlipidemia interventions must be targeted to individual patients' needs, with sequencing and frequency of contact tailored to the various stages of behavioral change.
Collapse
Affiliation(s)
- Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
- Department of Behavioral Sciences, Duke University, Durham, NC, USA
- Correspondence: Hayden B Bosworth, Health Services Research and Development (152), Suite 600, 411 West Chapel Hill Street, Durham, NC 27701, USA, Tel +1 919 286 6936, Fax +1 919 416 5836, Email
| | | | - Jan Liska
- Center of Excellence for Patient Centricity, Sanofi, Paris, France
| | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Caroline Atlani
- Patient Strategy, Diabetes & Cardiovascular Unit, Sanofi, Paris, France
| | - Anne C Beal
- Center of Excellence for Patient Centricity, Sanofi, Paris, France
| |
Collapse
|
26
|
Matthys E, Remmen R, Van Bogaert P. An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care? BMC FAMILY PRACTICE 2017; 18:110. [PMID: 29273023 PMCID: PMC5741858 DOI: 10.1186/s12875-017-0698-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 12/12/2017] [Indexed: 01/08/2023]
Abstract
Background Primary care needs to be strengthened in order to address the many societal challenges. Group practices in primary care foster collaboration with other health care providers, which encourages care co-ordination and leads to a higher quality of primary care. Nursing roles and responsibilities expanded over time and nurses have been found to often provide equal high-quality chronic patient care compared to physicians, even with higher patient satisfaction. Inter-professional collaboration between primary care physicians and nurses is a possible strategy to achieve the desired quality outcomes in a strengthened primary care system. The objective of this research is to synthesize the evidence presented in literature on the impact of collaboration between physicians and nurses on patient outcomes in primary care or in comparable care settings. Methods A systematic review of peer-reviewed reviews was performed in four databases: COCHRANE, MEDLINE, EMBASE and CINAHL. All studies from 1970 until May 22 2016 were included in the search strategy. Titles, abstracts and full texts were respectively reviewed. At least two of the three authors independently reviewed each of the 277 abstracts and 58 full texts retrieved in the searches to identify those which contained all the inclusion criteria. Two authors independently appraised the methodological quality of the reviews, using the AMSTAR quality appraisal tool. Results A total of eleven systematic reviews met all the inclusion criteria and almost fifty different patient outcomes were described. In most reviews, it was concluded that nurses do have added value. Blood pressure, patient satisfaction and hospitalization are patient outcomes where three or more systematic reviews concluded better results when physicians and nurses collaborated, compared to usual care. Colorectal screening, hospital length of stay and health-related quality of life are outcomes where collaboration appeared not to be effective. Conclusions Collaboration between physicians and nurses may have a positive impact on a number of patient outcomes and on a variety of pathologies. To address future challenges of primary care, there is a need for more integrated inter-professional collaboration care models with sufficiently educated nurses. Electronic supplementary material The online version of this article (10.1186/s12875-017-0698-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Evi Matthys
- University of Antwerp, Campus Drie Eiken DR334, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Roy Remmen
- University of Antwerp, Campus Drie Eiken DR334, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Peter Van Bogaert
- University of Antwerp, Campus Drie Eiken DR334, Universiteitsplein 1, 2610, Wilrijk, Belgium
| |
Collapse
|
27
|
Huber D, Henriksson R, Jakobsson S, Mooe T. Nurse-led telephone-based follow-up of secondary prevention after acute coronary syndrome: One-year results from the randomized controlled NAILED-ACS trial. PLoS One 2017; 12:e0183963. [PMID: 28886083 PMCID: PMC5590865 DOI: 10.1371/journal.pone.0183963] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/10/2017] [Indexed: 12/03/2022] Open
Abstract
Background Secondary prevention after acute coronary syndrome (ACS) could reduce morbidity and mortality, but guideline targets are seldom reached. We hypothesized that nurse-led telephone-based intervention would increase adherence. Methods The NAILED ACS trial is a prospective, controlled, randomized trial. Patients admitted for ACS at Östersund hospital, Sweden, were randomized to usual follow-up by a general practitioner or a nurse-led intervention. The intervention comprised telephone follow-up after 1 month and then yearly with lifestyle counselling and titration of medications until reaching target values for LDL-C (<2.5 mmol/L) and blood pressure (BP; <140/90 mmHg) or set targets were deemed unachievable. This is a 12-month exploratory analysis of the intervention. Results A total of 768 patients (396 intervention, 372 control) completed the 12-month follow-up. After titration at the 1-month follow-up, mean LDL-C was 0.38 mmol/L (95% CI 0.28 to 0.48, p<0.05), mean systolic BP 7 mmHg (95% CI 4.5 to 9.2, p<0.05), and mean diastolic BP 4 mmHg (95% CI 2.4 to 4.1, p<0.05) lower in the intervention group. Target values for LDL-C and systolic BP were met by 94.1% and 91.9% of intervention patients and 68.4% and 65.6% of controls (p<0.05). At 12 months, mean LDL was 0.3 mmol/L (95% CI 0.1 to 0.4, p <0.05), systolic BP 1.5 mmHg (95% CI -1.0 to 4.1, p = 0.24), and mean diastolic BP 2.1 mmHg (95% CI 0.6 to 3.6, p <0.05) lower in the intervention group. Target values for LDL-C and systolic BP were met in 77.7% and 68.9% of intervention patients and 63.2% and 63.7% of controls (p<0.05 and p = 0.125). Conclusion Nurse-led telephone-based secondary prevention was significantly more efficient at improving LDL-C and diastolic BP levels than usual care. The effect of the intervention declined between 1 and 12 months. Further evaluation of the persistence to the intervention is needed.
Collapse
Affiliation(s)
- Daniel Huber
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development—Östersund, Umeå University, Umeå, Sweden
- * E-mail:
| | - Robin Henriksson
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development—Östersund, Umeå University, Umeå, Sweden
| | - Stina Jakobsson
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development—Östersund, Umeå University, Umeå, Sweden
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development—Östersund, Umeå University, Umeå, Sweden
| |
Collapse
|
28
|
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).
Collapse
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
| |
Collapse
|
29
|
Taniguchi C, Tanaka H, Saka H, Oze I, Tachibana K, Nozaki Y, Suzuki Y, Sakakibara H. Cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status among patients who received smoking cessation intervention with nurses’ counselling. J Adv Nurs 2017; 73:1681-1695. [DOI: 10.1111/jan.13258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Chie Taniguchi
- Department of Nursing; Sugiyama Jogakuen University; Nagoya Japan
- Department of Nursing; Nagoya University Graduate School of Medicine; Nagoya Japan
- Nagoya Medical Center; Clinical Research Center; Nagoya Japan
| | - Hideo Tanaka
- Division of Epidemiology and Prevention; Aichi Cancer Center Research Institute; Nagoya Japan
- Department of Epidemiology; Nagoya University Graduate School of Medicine; Japan
| | - Hideo Saka
- Department of Respiratory Medicine and Medical Oncology; National Hospital Organization Nagoya Medical Center; Nagoya Japan
| | - Isao Oze
- Division of Epidemiology and Prevention; Aichi Cancer Center Research Institute; Nagoya Japan
| | - Kazunobu Tachibana
- Department of Education and Training; Department of Respiratory Medicine; National Hospital Organization Kinki-Chuo Chest Medical Center; Sakai Japan
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine; Japan Community Healthcare Organization Chukyo Hospital; Nagoya Japan
| | - Yukio Suzuki
- Department of Respiratory Medicine; Kitasato University Kitasato Institute Hospital; Tokyo Japan
| | - Hisataka Sakakibara
- Department of Nursing; Nagoya University Graduate School of Medicine; Nagoya Japan
| |
Collapse
|