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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?


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.


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.



Coronary events
Adverse events caused by conditions affecting the coronary arteries that supply oxygen and blood to the heart.
Coronary heart disease
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
Risk factors
Aspects making a condition more likely.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

  • Coronary artery disease risk screening

    Health Link B.C.
    Men over 40 and women past menopause or over 50 should get screened for coronary artery disease (CAD) every 1 to 3 years. Your risk is higher if you have diabetes, high blood pressure, abdominal obesity, kidney disease, family history of CAD or if you smoke.
  • High cholesterol: Does reducing the amount of fat in your diet help?

    Informed Health Online
    Eat less saturated fats in your diet to help prevent heart disease. Eat less meat, butter, cheese and cream to improve your health long-term.
  • Statins: Should I Take Them to Prevent a Heart Attack or Stroke?

    This patient decision aid helps people considering taking medicines called statins to lower their risk of heart attack and stroke by comparing the benefits, risks, and side effects of both options. It also includes alternative treatment options to taking statins such as trying to lower risk with lifestyle changes.
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