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Nurse-led clinics offer support for people with heart disease

The Bottom Line

  • Nurse-led clinics provide primary care as well as prevention, management and support for a wide variety of medical conditions, including cardiovascular diseases (CVD) such as heart disease and stroke.
  • Care and support at nurse-led clinics helps patients with CVD manage their medications and make and maintain lifestyles changes, leading to long-term health and survival of patients compared to usual care.
  • Future research is necessary to learn more about long-term benefits and as well as how best to implement nurse-led clinics

First, the good news: more people are surviving events like heart attacks and strokes caused by cardiovascular diseases (CVD). Although CVD remains a leading cause of death and illness world-wide, in the past 40 years the death rate from CVD has dropped dramatically in Canada, and many other countries (1,2).


Now the not-so-good news: while advancement in treatment means fewer people die from a heart attack or stroke, it doesn’t necessarily mean survivors go on to lead healthy and active lives for their remaining years. Many survivors are at risk of experiencing subsequent health crises due in large part to not knowing what they need to do to recover and not being successful in maintaining the kinds of lifestyle changes that will help keep them healthy (1). A poll conducted by the Canadian Heart and Stroke Foundation in 2013 of more than 2,000 heart attack and stroke survivors found that many find it difficult to make and maintain important changes such as getting enough physical activity, managing stress and maintaining a healthy weight (1).


With increasing numbers of people living with CVD (2), and millions of Canadians without a family doctor who can help them manage their chronic health conditions (3), nurse-led clinics are one way to bridge the gap between patient needs and health care resources. Canada is a world leader in implementing clinics staffed by nurses and nurse-practitioners to help ensure patients can access health and medical care that meets their needs. For example, more than 20 nurse practitioner-led clinics currently offer care throughout Ontario, and in Manitoba QuickCare clinics offer nurse-led urgent care for walk-in and after-hours patients.


Nurse-led clinics deliver a comprehensive set of services including primary care, management of chronic diseases and conditions, referrals to other services, health education and promotion (4)... but do they actually benefit patient health?


To address this question, twelve randomized controlled trials were included in a recent systematic review that explored whether nurse-led clinics (in Canada, the US and the UK) help to improve health and decrease death rates among patients with heart disease (5). The studies involved close to 10,000 participants, all of whom had suffered serious heart problems including heart attacks and strokes. The study group received follow-up treatment and care at nurse-led clinics and a control group received the usual care.


What the research tells us

Nurse-led clinics were shown to significantly reduce death rates – not only from heart disease but from all causes. They also were effective in helping patients consistently take their medications as prescribed, and in maintaining healthy lifestyle choices (eg. diet).


The included studies were rated as ‘moderate quality’ and varied greatly in the types and complexity of treatment offered, the condition of the patients and the expertise of the nurses offering care. While the currently available evidence supports nurse-led clinics, the review authors suggest additional studies are needed to determine their long-term benefits as well as how best to implement nurse-led care (5).


Nurse-led clinics may be your solution to getting the information, referrals and medical care that meets your needs. Check with your local health authority to learn more, including how to become a patient at a nurse-led clinic.


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References

  1. Health and Stroke Foundation. 2014 Report on the health of Canadians [Internet] Canada. Feb, 2014. [cited Nov 2015]. Available from: https://www.heartandstroke.ca/-/media/pdf-files/canada/2017-heart-month/heartandstroke-reportonhealth-2014.ashx?la=en&hash=9860137823BF864C3DE8B4CBBD9F57826A7C40C3
  2. Public Health Agency of Canada. Tracking heart disease and stroke in Canada [Internet] Canada. 2009. [cited Nov 2015]. Available from: http://www.phac-aspc.gc.ca/publicat/2009/cvd-avc/pdf/cvd-avs-2009-eng.pdf 
  3. Statistics Canada. Access to a regular medical doctor, 2013 [Internet] Canada. June 12, 2014. [cited Nov 2015]. Available from: http://www.statcan.gc.ca/pub/82-625-x/2014001/article/14013-eng.htm
  4. Ontario Ministry of Health and Long-Term Care. Nurse practitioner-led clinics [Internet] Ontario, Canada. May 21, 2015. [cited Nov 2015]. Available from: http://www.health.gov.on.ca/en/common/system/services/npc/ 
  5. Al-Mallah MH, Farah I, Al Madani W et al. The impact of nurse-led clinics on the mortality and morbidity of patients with cardiovascular diseases: A systematic review and meta-analysis. J Cardiovasc Nurs. 2015 
  6. McClure T, Haykowsky MJ, Schopflocher D, et al. Home-based secondary prevention programs for patients with coronary artery disease: a meta-analysis of effects on anxiety. J Cardiopulm Rehabil Prev. 2013; 33(2): 59-67 
  7. Fergenbaum J, Bermingham S, Krahn M, et al. Care in the home for the management of chronic heart failure: Systematic review and cost-effectiveness analysis. J Cardiovasc Nurs. 2015

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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