The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: a prospective cohort study.
BACKGROUND
Patients with acute myocardial infarction (AMI) are at high risk for reinfarction and death. Therapies that have been shown to reduce these risks (secondary prevention) continue to be underutilized. Nurse practitioners are well positioned to provide secondary prevention during and following hospitalization.


OBJECTIVE
The purpose of this study was to evaluate the effects of NP care on the rate of provider implementation and patient achievement of evidence-based secondary prevention target goals.


METHODS
A prospective cohort design was used, which compared achievement of target goals between patients who received secondary prevention care from an NP to those who received usual care.


METHODS
The sample consisted of 65 patients with AMI, admitted to a large community hospital. Patients meeting eligibility criteria were recruited consecutively.


METHODS
The intervention was delivered by the NP before discharge from hospital and one week, two weeks, six weeks and 3 months after discharge. Data on patients' achievement of goals were obtained before discharge from hospital and 3 months after discharge from both groups.


RESULTS
This study's results provide preliminary evidence that an NP delivered secondary prevention intervention can significantly improve achievement of the following target goals when compared to usual care: smoking cessation (OR 5), blood pressure (OR 15), attendance at cardiac rehabilitation (OR 7), physical activity five days a week (OR 17), physical activity ≥ five days a week (OR 34), achieving a glycated haemoglobin < 7% in those with diabetes (OR 10), triglyceride levels (p = .02), statin use at follow-up (p = .05), and number of weeks to cardiac rehabilitation (p = .05).


CONCLUSIONS
NP-led interventions such as this warrant duplication to evaluate reproducibility of the intervention and to determine if short-term improvements in secondary prevention goals translate into morbidity and mortality benefits.
Health Interventions Research Centre, Ryerson University, Toronto, Canada; Trillium Health Partners, Mississauga, Ontario, Canada; Canadian Centre for Advanced Practice Nursing Research, McMaster University, Hamilton, Ontario, Canada. Electronic address: pharbman@sympatico.ca.
Patricia
P
Harbman
D006801:Humans; D009203:Myocardial Infarction / Q000451:nursing / Q000517:prevention & control*; D009722:Nurse Practitioners; D010353:Patient Education as Topic; D011446:Prospective Studies; D055502:Secondary Prevention
Acute myocardial infarction; Cohort design; Guideline adherence; Nurse practitioner; Risk factors; Secondary prevention