title: The Impact of Nurse-Led Clinics on the Mortality and Morbidity of Patients with Cardiovascular Diseases: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Nurse-led clinics (NLCs) have been developed in several health specialties in recent years. The aim of this analysis is to summarize and appraise the available evidence about the effectiveness of NLCs on the morbidity and mortality outcomes in patients with cardiovascular diseases (CVDs).
  
  
  METHODS
  We searched Cochrane databases, MEDLINE, Web of Science, PubMed, EMBASE, Google Scholar, BIOSIS, and bibliography of secondary sources from inception through February 20, 2013. Studies were selected and data were extracted independently by 2 investigators. Eligible studies were randomized trials of NLCs of patients with CVD. Of 56 potentially relevant articles screened initially, 12 trials met the inclusion criteria. The outcomes of interest were all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, major adverse cardiac events, revascularization, lipids control, and adherence to antiplatelet medications. We performed random-effects meta-analysis to estimate summary risk ratios and quantified between-studies heterogeneity with the I2 statistic.
  
  
  RESULTS
  The 12 trials allocated 4886 patients to NLCs and 4954 patients to usual care. The NLC patients had decreased all-cause mortality (odds ratio, 0.78; 95% confidence interval [CI], 0.65-0.95; P < .01) and myocardial infarction (odds ratio, 0.63; 95% CI, 0.39-1.00; P = .05) and had higher adherence to lipid-lowering medication (odds ratio, 1.57; 95% CI, 1.14-2.17; P = .006) compared with controls. They also had increased adherence to antiplatelet therapy compared with controls (odds ratio, 1.42; 95% CI, 1.01-1.98; P = .04). There was no statistically significant difference in the risk of cardiovascular death (odds ratio, 0.68; 95% CI, 0.40-1.15; P = .68), major adverse cardiac events (odds ratio, 0.79; 95% CI, 0.55-1.14; P = .21),or revascularization (odds ratio, 0.87; 95% CI, 0.66-1.16; P = .36) between NLC patients and controls.
  
  
  CONCLUSIONS
  The available evidence suggests a favorable effect of NLCs on all-cause mortality, rate of major adverse cardiac events, and adherence to medications in patients with CVD.
authors: Mouaz H. Al-Mallah, MD, MSc, FACC, FAHA, FESC King Saud Bin Abdulaziz University for Health Sciences; Associate Professor of Medicine, Consultant Cardiologist, King Abdulaziz Cardiac Center, King Abdulaziz Medical City; and National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA. Iyad Farah, RN Nurse Specialist, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, KSA. Wedad Al-Madani, MSc King Saud Bin Abdulaziz University for Health Sciences; and Coordinator, National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA. Bassam Bdeir, MD King Saud Bin Abdulaziz University for Health Sciences; and Director Cardiac Clinics and Cardiovascular Disease Management Program, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, KSA. Samia Al Habib, MD, PhD King Saud Bin Abdulaziz University for Health Sciences; Family Medicine and Primary Health Care Department, King Abdelaziz Medical City; and National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA. Maureen L. Bigelow, RN Assistant Professor of Nursing, Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota. Mohammad Hassan Murad, MD, MPH Professor of Medicine, Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota. Mazen Ferwana, MD, PhD King Saud Bin Abdulaziz University for Health Sciences; Family Medicine and Primary Health Care Department, King Abdelaziz Medical City; and National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA.
authors: Mouaz H
authors: MH
authors: Al-Mallah
authors: Iyad
authors: I
authors: Farah
authors: Wedad
authors: W
authors: Al-Madani
authors: Bassam
authors: B
authors: Bdeir
authors: Samia
authors: S
authors: Al Habib
authors: Maureen L
authors: ML
authors: Bigelow
authors: Mohammad Hassan
authors: MH
authors: Murad
authors: Mazen
authors: M
authors: Ferwana
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality* / Q000451:nursing; D006801:Humans; D057184:Practice Patterns, Nurses'