Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study
Background Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. Method This singl...
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| Published in | BMC cardiovascular disorders Vol. 18; no. 1; pp. 167 - 9 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
15.08.2018
BioMed Central Ltd Springer Nature B.V BMC |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1471-2261 1471-2261 |
| DOI | 10.1186/s12872-018-0907-0 |
Cover
| Abstract | Background
Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes.
Method
This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (
n
= 105) had a routine cardiologist consultation, while for those receiving tailored care (
n
= 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year.
Results
Patients in the tailored group achieved better control of total cholesterol (− 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12–14-month follow-up, (
p
= 0.01), LDL cholesterol (− 0.1 vs + 0.2 mmol/L,
p
= 0.02) and systolic blood pressure (− 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1–1.0),
p
= 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (
p
< 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (
p
= 0.02).
Conclusion
A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. |
|---|---|
| AbstractList | Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. This single-centre retrospective observational study included 217 patients (62 [+ or -] 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. Background: Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. Method: This single-centre retrospective observational study included 217 patients (62±9years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n=105) had a routine cardiologist consultation, while for those receiving tailored care (n=112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. Results: Patients in the tailored group achieved better control of total cholesterol (-0.1 vs+0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p=0.01), LDL cholesterol (-0.1 vs+0.2 mmol/L, p=0.02) and systolic blood pressure (-2.1 vs+4.3 mmHg, p=0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p=0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p<0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p=0.02). Conclusion: A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. Abstract Background Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. Method This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. Results Patients in the tailored group achieved better control of total cholesterol (− 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12–14-month follow-up, (p = 0.01), LDL cholesterol (− 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (− 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1–1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). Conclusion A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. Background Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. Method This single-centre retrospective observational study included 217 patients (62 [+ or -] 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. Results Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). Conclusion A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. Keywords: Cardiac rehabilitation, Secondary prevention, Acute myocardial infarction, Cardiovascular risk factors, Nurse-led care Background Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. Method This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care ( n = 105) had a routine cardiologist consultation, while for those receiving tailored care ( n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. Results Patients in the tailored group achieved better control of total cholesterol (− 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12–14-month follow-up, ( p = 0.01), LDL cholesterol (− 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (− 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1–1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group ( p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group ( p = 0.02). Conclusion A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes.BACKGROUNDCardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes.This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year.METHODThis single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year.Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02).RESULTSPatients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02).A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.CONCLUSIONA tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients. According to Swedish national registries, 18% of acute myocardial infarction (AMI) survivors suffer a second CVD event in the first year and approximately 50% of major coronary artery disease events occur in those with a previous hospital discharge diagnosis of AMI [2]. Table 1 Study parameters, definitions, targets and measurements Parameter Definition Target Measurement Smoking Active smoker yes/no Smoking cessation Self-reported Exercise training Reaching target for exercise training Fitness training 20–60 min at least three times a week and muscular resistance training at least two times a week equivalent 12–16 at Borg’s perceived exertion scale [19] Participation in hospital-based exercise training, verified by hospital records Physical activity Reaching target for physical activity Any physical activity at least 30 min per day corresponding a brisk walk Self-reported Overweight BMI ≥ 25 kg/m2 Weight loss with target BMI <25 kg/m2 Height in m and weight in kg measured at follow-up visits Hypertension SBP ≥140 mmHg DBP ≥90 mmHg SBP < 140 mmHg DBP < 90 mmHg With a manual sphygmomanometer with subject in sitting position after 5 min of rest Blood lipids (mmol/L) above therapeutic goal TC ≥ 4.5 TC < 4.5 Fasting blood samples (plasma): TC, LDL, HDL, TG LDL ≥ 1.8 LDL < 1.8 HDL ≤ 1.0 HDL > 1.0 (men) HDL ≤ 1.2 HDL > 1.2 (women) TG ≥ 1.7 TG < 1.7 Cardioprotective medication ACEi/ARB, β-blocker, antiplatelet- and lipid-lowering medication Maximum adherence to treatment Self-reported Hospital readmission Readmission due to CVD Avoidance Hospital records BMI Body mass index, SBP systolic blood pressure, DBP diastolic blood pressure, TC total cholesterol, TG triglycerides, LDL low density lipoprotein, HDL high density lipoprotein, CVD cardiovascular disease The study group was divided by a timeline. [...]29 patients were, after an individual evaluation by the CR teams nurse, scheduled for a follow-up visit with a cardiologist. [...]in total, 60% (n = 67 out of 112) of the patients had at least one cardiologist consultation during the follow-up period. [...]patients in the tailored group were not referred to primary care until after the 12–14-month follow-up visit with a nurse. |
| ArticleNumber | 167 |
| Audience | Academic |
| Author | Schiopu, Alexandru Nilsson, Marie Ögmundsdottir Michelsen, Halldora Sjölin, Ingela Leosdottir, Margret Scherstén, Fredrik |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30111283$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_2174_1871530322666220331154354 crossref_primary_10_1002_hcs2_116 crossref_primary_10_1111_2047_3095_12417 crossref_primary_10_1111_resp_14322 crossref_primary_10_3390_healthcare12242497 crossref_primary_10_1097_HCR_0000000000000881 crossref_primary_10_53730_ijhs_v4nS1_15460 crossref_primary_10_3390_ijerph16245126 crossref_primary_10_1056_NEJMra2302291 |
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| CorporateAuthor | Lunds universitet Profile areas and other strong research environments Department of Clinical Sciences, Malmö Lund University Strategiska forskningsområden (SFO) EpiHealth: Epidemiology for Health EXODIAB: Excellence of Diabetes Research in Sweden Faculty of Medicine Internmedicin - epidemiologi Strategic research areas (SRA) Medicinska fakulteten Kardiovaskulär forskning - immunitet och ateroskleros Cardiovascular Research - Immunity and Atherosclerosis Profilområden och andra starka forskningsmiljöer Institutionen för kliniska vetenskaper, Malmö Internal Medicine - Epidemiology |
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| Keywords | Secondary prevention Acute myocardial infarction Cardiovascular risk factors Nurse-led care Cardiac rehabilitation |
| Language | English |
| License | Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. cc-by |
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| Snippet | Background
Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The... Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the... Background Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The... According to Swedish national registries, 18% of acute myocardial infarction (AMI) survivors suffer a second CVD event in the first year and approximately 50%... Background: Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The... Abstract Background Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is... |
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| SubjectTerms | Acute myocardial infarction Aged Angiology Blood Pressure Blood Transfusion Medicine Body weight loss Cardiac rehabilitation Cardiac Rehabilitation - nursing Cardiac Surgery Cardiologists Cardiology Cardiology and Cardiovascular Disease Cardiovascular disease Cardiovascular diseases Cardiovascular risk factors Clinical Medicine Complications and side effects Coronary artery Coronary artery disease Coronary vessels Diagnosis Disease prevention Exercise Female Fitness training programs Health Sciences Health Status Heart attack Heart attacks Humans Hälsovetenskap Internal Medicine Kardiologi och kardiovaskulära sjukdomar Klinisk medicin Lipids - blood Male Medical and Health Sciences Medicin och hälsovetenskap Medicine Medicine & Public Health Middle Aged Myocardial infarction Myocardial Infarction - diagnosis Myocardial Infarction - nursing Myocardial Infarction - physiopathology Myocardial Infarction - rehabilitation Nurse's Role Nurse-led care Nursing Observational studies Omvårdnad Patient Compliance Patient Readmission Patients Physical fitness Referral and Consultation Rehabilitation Research Article Retrospective Studies Risk Factors Risk Reduction Behavior Secondary prevention Smoking Cessation Studies Sweden Time Factors Treatment Outcome Weight Loss |
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| Title | Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study |
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