Cardiovascular Risk Factors and Visiting Nurse Intervention -Evaluation of a Croatian Survey and Intervention Model: the CroHort Study (original) (raw)
The Lancet, 2008
Background Our aim was to investigate whether a nurse-coordinated multidisciplinary, family-based preventive cardiology programme could improve standards of preventive care in routine clinical practice. Methods In a matched, cluster-randomised, controlled trial in eight European countries, six pairs of hospitals and six pairs of general practices were assigned to an intervention programme (INT) or usual care (UC) for patients with coronary heart disease or those at high risk of developing cardiovascular disease. The primary endpoints-measured at 1 year-were family-based lifestyle change; management of blood pressure, lipids, and blood glucose to target concentrations; and prescription of cardioprotective drugs. Analysis was by intention to treat. The trial is registered as ISRCTN 71715857. Findings 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC, respectively. In patients with coronary heart disease who smoked in the month before the event, 136 (58%) in the INT and 154 (47%) in the UC groups did not smoke 1 year afterwards (diff erence in change 10•4%, 95% CI −0•3 to 21•2, p=0•06). Reduced consumption of saturated fat (196 [55%] vs 168 [40%]; 17•3%, 6•4 to 28•2, p=0•009), and increased consumption of fruit and vegetables (680 [72%] vs 349 [35%]; 37•3%, 18•1 to 56•5, p=0•004), and oily fi sh (156 [17%] vs 81 [8%]; 8•9%, 0•3 to 17•5, p=0•04) at 1 year were greatest in the INT group. High-risk individuals and partners showed changes only for fruit and vegetables (p=0•005). Blood-pressure target of less than 140/90 mm Hg was attained by both coronary (615 [65%] vs 547 [55%]; 10•4%, 0•6 to 20•2, p=0•04) and high-risk (586 [58%] vs 407 [41%]; 16•9%, 2•0 to 31•8, p=0•03) patients in the INT groups. Achievement of total cholesterol of less than 5 mmol/L did not diff er between groups, but in high-risk patients the diff erence in change from baseline to 1 year was 12•7% (2•4 to 23•0, p=0•02) in favour of INT. In the hospital group, prescriptions for statins were higher in the INT group (810 [86%] vs 794 [80%]; 6•0%, −0•5 to 11•5, p=0•04). In general practices in the intervention groups, angiotensin-converting enzyme inhibitors (297 [29%] INT vs 196 [20%] UC; 8•5%, 1•8 to 15•2, p=0•02) and statins (381 [37%] INT vs 232 [22%] UC; 14•6%, 2•5 to 26•7, p=0•03) were more frequently prescribed. Interpretation To achieve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to individual countries, which are accessible by all hospitals and general practices caring for coronary and high-risk patients. Funding European Society of Cardiology through an unconditional educational grant from AstraZeneca.
International Journal of Nursing Studies, 2010
Background: Studies have shown that in general patients are positive about cardiovascular prevention delivered by general practitioners. Further, it has been found that care by nurses for the chronically ill leads to even greater patient satisfaction. Objective: The aim of this survey was to answer the following questions: How do patients perceive cardiovascular prevention delivered by the practice nurse? Are patient characteristics and personal health status associated with experiences of received nurse-led care? Design: A cross-sectional survey after completion of a randomised trial. Setting: Six primary health care centres in the Netherlands (25 general practitioners, 6 practice nurses, 30,000 patients). Participants: Included in the randomised trial were 701 patients with at least a 10% risk of fatal cardiovascular disease within 10 years. Patients who visited a cardiovascular specialist more often than once a year and patients with diabetes were excluded from the study. In 90% of the patients it concerned secondary prevention. Half of the patients received nursedelivered care and half received care by the general practitioner. Method: A questionnaire was sent by post to all patients after having received one year of cardiovascular prevention. A dual moderator focus group study was held for the development of the questionnaire. Findings: The response rate was 69%. Patients were more satisfied with nurse-delivered cardiovascular prevention compared to standard care by general practitioners. The majority of patients agreed with positive statements regarding received nurse-led care. Patient characteristics such as age, educational level and gender were significantly associated with patients experiences. Furthermore, a significant association between experiences and personal health status was found. In comparison with patients who did not smoke, smokers would recommend the practice nurse less to others (X 2 = 4.0, p = 0.047), felt more 'rapped on their knuckles' (X 2 = 11.5, p = 0.003), found the consultation more 'awkward' (X 2 = 8.3, p = 0.016) and thought the nurse less understanding of their personal situation (X 2 = 6.4, p = 0.041) and less able to explain clearly (X 2 = 6.5, p = 0.039). Conclusions: The majority of patients responded positively to nurse-delivered cardiovascular prevention. Further improvement could be gained by paying more attention to motivational interviewing. Nurses should approach high risk patients more specifically according to the type of risk factor to be treated. ß
Cardiovascular diseases, risk factors and barriers in their prevention in Croatia
Collegium antropologicum, 2009
Cardiovascular diseases are the leading cause of death in Croatia, with significant regional differences. Despite high mortality rates, high prevalence of various cardiovascular risk factors and well organized public health network, comprehensive system for cardiovascular disease monitoring and interventions does not exist. In this study we analyzed legislation framework and responsibilities of stakeholders relevant for cardiovascular disease surveillance and prevention. According to the international experiences we analyzed characteristics of cardiovascular disease prevention in Croatia and causes of the problems appeared in the preventive programs in Croatia. Analysis showed that primary problem is not inefficiency, but the existence of barriers in preventive activities definition, responsibilities distribution and task implementation. Main cause for such situation is incompatibility of the existing practices in clinical medicine and public health with recommendations from other c...
International Journal of Nursing and Health Services (IJNHS)
Health promotion is a method to increase awareness of healthy behavior in public. Unhealthy lifestyles cause increases the risk of cardiovascular disease. Community health nurses have a responsibility to increase the motivation of healthy practice with the health promotion’s method. This research method used a systematic review, using online databases on Cambridge Core, Wiley Online, and Science Direct e-resources when the articles published from 2006-2018. The selection of literature used the Critical Capability Program (CASP) tool and got eight relevant articles. The systematic analysis used the Cochrane Collaboration. The themes of this article are 1) nurses’ knowledge about health promotion, 2) the meaning of health promotion, and 3) the implementation health promotion of cardiovascular disease prevention by nurses. The themes identified some categories, such as nurse responsibilities, the essence of health promotion, support and barriers, and health promotion’s method. The nurs...
BMJ Open, 2019
IntroductionNearly 90% of all deaths in the Republic of Moldova are caused by non-communicable diseases, the majority of which (55%) are caused by cardiovascular diseases (CVD). In addition to reducing premature mortality from CVD, it is estimated that strengthening primary healthcare could cut the number of hypertension-related hospital admissions and diabetes-related hospitalisations in half. The aim of this evaluation is to determine the feasibility of implementing and evaluating essential interventions for the prevention of CVD in primary healthcare in the Republic of Moldova, with a view towards national scale-up.Methods and analysisA national steering group including international experts will be convened to adapt WHO Package of Essential NCD Intervention from Primary Healthcare in Low Resource Settings protocols 1 and 2 to the health system of the Republic of Moldova, develop and conduct training of primary healthcare workers and test a core set of indicators to monitor the q...
Heart, 2013
Objective To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only. Design RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial. Setting Multicentre trial in secondary and tertiary healthcare settings. Participants 754 patients admitted for acute coronary syndrome. Intervention A nurse-coordinated prevention programme, consisting of four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care. Main outcome measures The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months followup. Secondary outcomes included Framingham Coronary Risk Score at 12 months, in addition to changes in individual risk factors. Risk factor control was classified as 'poor' if 0 to 3 factors were on target, 'fair' if 4 to 6 factors were on target, and 'good' if 7 to 9 were on target. Results The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2) in the control group (p=0.021), representing a 17.4% relative risk reduction. At 12 months, risk factor control classified as 'good' was achieved in 35% of patients in the intervention group compared with 25% in the control group (p=0.003). Attendance to the nurse-coordinated prevention programme was 92%. In the intervention group, 86 rehospitalisations were observed against 132 in the control group (relative risk reduction 34.8%, p=0.023). Conclusions The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction of cardiovascular risk in patients with coronary disease. Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions. Trial Registration trialregister.nl Identifier TC1290.