title: Nurse-led risk assessment/management clinics reduce predicted cardiac morbidity and mortality in claudicants.
abstract: Nurse-led assessment/management of risk factors is effective in many chronic medical conditions. We aimed to evaluate whether this finding was true for patients with intermittent claudication and to analyze its impact on patient-reported quality of life and predicted mortality due to coronary heart disease. We prospectively studied a series of 78 patients (51 men; median age, 65 years [IQR: 56-74 years]), diagnosed with intermittent claudication and referred to a nurse-led risk assessment/management clinic (NLC) from a consultant-led vascular surgical clinic. The NLC used clinical care pathways to manage antiplatelet medication, smoking cessation, hyperlipidemia, hypertension, and diabetes and to provide exercise advice. All patients were reassessed at a 3 months. Medication compliance, smoking status, fasting lipid profiles, blood pressure, and HbA1c were recorded. Disease-specific quality of life was assessed using King's College VascuQoL and predicted cardiac morbidity and mortality were calculated using the PROCAM and Framingham risk scores. We found that NLC enrollment produced an antiplatelet and a statin compliance of 100%, a smoking cessation rate of 17% (9 patients) and significant improvements in total cholesterol (median, 5.2-4.5 mmol/l), LDL (median, 3.1-2.5 mmol/l) and triglyceride (median, 1.7-1.4 mmol/l) levels. Significant disease-specific quality of life improvements and significant reduction in both the PROCAM (14% to 10%) and Framingham (14% to 11%) coronary risk scores were observed. Providing care at NLCs for claudicants is effective in assessing and managing risk factors, improves disease-specific quality of life and reduces predicted morbidity and mortality due to coronary heart disease.
authors.affiliation: Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom.
authors.forename: Josephine
authors.initials: J
authors.lastname: Hatfield
authors.forename: Sumit
authors.initials: S
authors.lastname: Gulati
authors.forename: Morhisham N A
authors.initials: MN
authors.lastname: Abdul Rahman
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coughlin
authors.forename: Ian C
authors.initials: IC
authors.lastname: Chetter
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000451:nursing; D015444:Exercise; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006949:Hyperlipidemias / Q000188:drug therapy / Q000451:nursing; D006973:Hypertension / Q000188:drug therapy / Q000451:nursing; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D024802:Nurse's Role; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation / Q000379:methods
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors