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RESPONSE: Nursing intervention led to significant, sustained reductions in CV risk
Peters R. Session 708003–708004.
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European Society of Cardiology Congress 2010
A 6-month nursing intervention in patients with recent history of an acute clinical coronary complication resulted in sustained reductions in cardiovascular risk, which researchers attribute to improved control of risk factors.
The Randomized Evaluation of Secondary Prevention by Outpatient Nurse Specialists (RESPONSE) study was a randomized clinical trial conducted in 11 centers in the Netherlands. It included 754 patients aged 18 to 80 years who were eligible if they had been admitted for an acute clinical coronary complication 8 weeks before inclusion.
Participants were then randomly assigned into two arms: those treated with usual care alone (control group, n=377) or those treated with a nurse-coordinated prevention program in addition to usual care (intervention group, n=377). The primary outcome of the study was the Systematic Coronary Risk Evaluation (SCORE) 10-year CV risk estimation at 12 months or 6 months after the last visit. SCORE incorporated age, sex, total cholesterol, systolic blood pressure and smoking status. Intervention included up to four outpatient visits to a nurse for the first 6 months after inclusion.
At 12 months, researchers reported SCORE to be 4.5% in the intervention group and 5.4% in the control group, which represented a 16.9 relative risk reduction (P=.029). Risk factor control at 12 months was classified as good in 35% of intervention group patients vs. 25% of those in the control group (P=.006). Adherence to medication was not significantly different between groups.
“A nurse-coordinated hospital-based prevention program with up to four outpatient clinic visits in addition to usual care results in sustained lowering of CV risk in patients with coronary disease,” Ron J. G. Peters, MD, with the Academic Medical Center, University of Amsterdam, and study researcher, said during his presentation. “The program was well attended, practical and can be readily implemented into daily practice.”
The RESPONSE trial provides further evidence that nurse-coordinated prevention programs are an effective means of improving secondary prevention in Europe. The RESPONSE trial, along with the EUROACTION program, has demonstrated the feasibility of nurse-coordinated prevention programs within European health care systems. Nurses are well-suited to this type of role, given that their educational preparation commonly includes behavioral change, counseling, communication and support to patients and families, as well as medical and nursing content. The public considers nurses a credible source of information, and nursing roles typically involve coordination of care and collaboration with physicians and other providers. This does not preclude other providers from coordinating this type of program but does indicate the suitability of nurses to take on this responsibility.
There is heterogeneity in nursing education and roles across Europe, but with appropriate standards, training and support nurse-coordinated prevention programs could be an integral component in reducing the burden of CV disease in Europe.
– Christi Deaton, PhD, RN
University of Manchester, Central Manchester Foundation
Trust
Manchester, U.K.