Nurse-coordinated care has positive outcomes for patients with coronary heart disease

Snaterse M, Dobber J, Jepma P, et al.  Effective components of nurse-coordinated care to prevent recurrent coronary events: A systematic review and meta-analysis Heart. 2015 November;102(1):50-56.

Review question

In patients with coronary heart disease, what is the effectiveness of nurse-coordinated care for reducing risk factors associated with heart disease and clinical events (e.g., coronary events, hospital readmissions), and for improving patient-perceived health?

Background

Patients with coronary heart disease are at a high risk of recurrent cardiovascular events (e.g., heart attacks,) and as a result, the disease is a major cause of deaths worldwide.

Guidelines have been recommended to reduce risk factors associated with heart disease. However, there is significant room for improvement in the extent to which clinical practice aligns with best practice recommendations.

Nurse-coordinated care for individuals who already have coronary heart disease could potentially improve patient health outcomes, but the programs differ widely, and the efficacy of such programs is not known.

How the review was done

A detailed search of a number of electronic databases for studies published from 1990 to 2015 was conducted. Studies that focused on patients being treated for coronary heart disease by a registered nurse who was coordinating care were included in the review.

A total of 3,524 studies were identified in searches, and 19 were included in the review after assessments for eligibility.

This review was funded by the Netherlands Organisation for Scientific Research.

What the researchers found

The review found that when nurses managed prescriptions and/or adjusted doses of medications that were done in a high intensity manner (i.e., greater than four visits plus more than one nurse-coordinated care strategy) for patients, the risk factors for recurrent cardiovascular events, such as blood pressure and cholesterol, could be reduced.

Compared to usual care, independent nurse prescribing and/or medication dose adjustment, behavioural therapy for patients (including goal setting) and frequent follow-up were more effective with improved patient outcomes.

Conclusion

This review found that nurse-coordinated care had positive effects on outcomes if the interventions were of high intensity, and included independent prescribing by nurses and/or adjusting the dose of medications, as well as behavioral interventions that included goal setting. Future studies should focus on establishing a standard definition of the interventions covered in this review in order to facilitate better comparisons of components and outcomes.