title: Outcomes of an integrated community-based nurse-led cardiovascular disease prevention programme.
abstract: National guidance for England recommends that cardiovascular disease (CVD) should be managed as a family of diseases in the community. Here, we describe the results of such an approach.
  
  
  
  Patients with established CVD or who were at high multifactorial risk (HRI) underwent a 12-week community-based nurse-led prevention programme (MyAction) that included lifestyle and risk factor management, prescription of medication and weekly exercise and education sessions.
  
  
  
  Over a 6-year period, 3232 patients attended an initial assessment; 63% were male, and 48% belonged to black and minority ethnic groups. 56% attended an end-of-programme assessment, and 33% attended a one year assessment. By the end of the programme, there was a significant reduction in smoking prevalence but only in HRI (-3.7%, p<0.001). Mediterranean diet score increased in both CVD (+1.2, p<0.001) and HRI (+1.5; p<0.001), as did fitness levels (CVD +0.8 estimated Mets maximum, p<0.001, HRI +0.9 estimated Mets maximum, p<0.001) and the proportions achieving their physical activity targets (CVD +40%, p<0.001, HRI +37%, p<0.001). There were significant increases in proportions achieving their blood pressure (CVD +15.4%, p<0.001, HRI +25%, p<0.001 and low-density lipoprotein cholesterol targets (CVD +6%, p=0.004, HRI +23%, p<0.001). Statins and antihypertensive medications significantly increased in HRI. Significant improvements in depression scores and quality-of-life measures were also seen. The majority of improvements were maintained at 1 year.
  
  
  
  These results demonstrate that an integrated vascular prevention programme is feasible in practice and reduces cardiovascular risk in patients with established CVD and in those at high multifactorial risk.
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Connolly
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kotseva
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Jennings
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Atrey
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.|College of Health and Life Sciences, Brunel University, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Jones
authors.affiliation: Public Health England, Fleetbank House, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Brown
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Bassett
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Wood
mesh_terms: D000072038:Cardiac Rehabilitation / Q000451:nursing*; D002318:Cardiovascular Diseases / Q000451:nursing / Q000517:prevention & control*; D003153:Community Health Services / Q000379:methods*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015397:Program Evaluation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: Cardiovascular disease prevention; cardiovascular risk factors; integrated care; lifestyle; rehabilitation