Identification of patients at risk of ischemic events for long-term secondary prevention.
OBJECTIVE
To review the identification of patients at risk of secondary ischemic events, discuss the therapies available for their medical management, and identify the role of the nurse practitioner (NP) in their primary and long-term care.


METHODS
ACC/AHA 2007 guidelines for the management of patients with unstable angina and non-ST-elevation myocardial infarction, ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease, AHA/ASA 2006 guidelines for patients with ischemic stroke, AHA/ACC 2006 guidelines update for patients with coronary and other atherosclerotic vascular disease, and selected clinical articles identified through PubMed.


CONCLUSIONS
Preventive therapy in patients with atherothrombotic vascular disease is critical for reducing the risk of recurrent events. Almost all patients with atherosclerotic disease will benefit from general lifestyle modifications, and most will also benefit from appropriate pharmacotherapies targeting dyslipidemia, diabetes, hypertension, and platelet function. However, evidence suggests that secondary prevention strategies may not be utilized effectively.


CONCLUSIONS
Increased awareness and implementation of clinical practice guidelines can reduce the risk of recurrent atherothrombotic events. NPs in primary care settings or in long-term care facilities are well placed to determine whether patients are receiving appropriate preventive care and to implement improvements in their management.
Brassard
Andrea
A
Department of Nursing Education, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA. npaaxb@gwumc.edu
D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008019:Life Style; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D009722:Nurse Practitioners / Q000458:organization & administration; D024802:Nurse's Role; D009730:Nursing Assessment; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors