title: Effective components of nurse-coordinated care to prevent recurrent coronary events: a systematic review and meta-analysis.
abstract: Current guidelines on secondary prevention of cardiovascular disease recommend nurse-coordinated care (NCC) as an effective intervention. However, NCC programmes differ widely and the efficacy of NCC components has not been studied. To investigate the efficacy of NCC and its components in secondary prevention of coronary heart disease by means of a systematic review and meta-analysis of randomised controlled trials. 18 randomised trials (11 195 patients in total) using 15 components of NCC met the predefined inclusion criteria. These components were placed into three main intervention strategies: (1) risk factor management (13 studies); (2) multidisciplinary consultation (11 studies) and (3) shared decision making (10 studies). Six trials combined NCC components from all three strategies. In total, 30 outcomes were observed. We summarised observed outcomes in four outcome categories: (1) risk factor levels (16 studies); (2) clinical events (7 studies); (3) patient-perceived health (7 studies) and (4) guideline adherence (3 studies). Compared with usual care, NCC lowered systolic blood pressure (weighted mean difference (WMD) 2.96 mm Hg; 95% CI 1.53 to 4.40 mm Hg) and low-density lipoprotein cholesterol (WMD 0.23 mmol/L; 95% CI 0.10 to 0.36 mmol/L). NCC also improved smoking cessation rates by 25% (risk ratio 1.25; 95% CI 1.08 to 1.43). NCC demonstrated to have an effect on a small number of outcomes. NCC that incorporated blood pressure monitoring, cholesterol control and smoking cessation has an impact on the improvement of secondary prevention. Additionally, NCC is a heterogeneous concept. A shared definition of NCC may facilitate better comparisons of NCC content and outcomes.
authors.affiliation: Amsterdam School of Health Professions, University of Applied Sciences, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Snaterse
authors.affiliation: Amsterdam School of Health Professions, University of Applied Sciences, Amsterdam, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Dobber
authors.affiliation: Amsterdam School of Health Professions, University of Applied Sciences, Amsterdam, The Netherlands.
authors.forename: Patricia
authors.initials: P
authors.lastname: Jepma
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
authors.affiliation: Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Gerben
authors.initials: G
authors.lastname: Ter Riet
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Buurman
authors.affiliation: Amsterdam School of Health Professions, University of Applied Sciences, Amsterdam, The Netherlands.
authors.forename: Wilma J M
authors.initials: WJ
authors.lastname: Scholte op Reimer
mesh_terms: D003327:Coronary Disease / Q000175:diagnosis / Q000451:nursing*; D019983:Guideline Adherence; D006801:Humans; D008019:Life Style; D024802:Nurse's Role; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome