The study's findings, published in the October issue of the American Heart Journal, "show that nurse case managers can greatly improve risk factor management in patients with coronary heart disease," says lead author Jerilyn Allen, ScD, RN, professor at the School of Nursing.
"Cardiovascular disease is the leading killer of Americans, accounting for 40 percent of deaths annually. Even though high cholesterol clearly increases the risk of heart disease, under-treatment of the condition is common," says Allen. "When heart disease patients discharged from the hospital after surgery aren't able to lower their cholesterol levels, they are likely to end up back in the hospital."
In addition to standard care, including information and instructions for activity, diet, and monitoring pulse and temperature, 228 male and female study participants were randomly assigned to one of two programs.
One group received usual follow-up care enhanced with cholesterol-lowering medication and written reports on cholesterol levels sent to the patient and the patient's primary care provider or cardiologist. In the other group, a nurse case manager offered individualized counseling, feedback on lifestyle modifications, and prescription and monitoring of cholesterol-lowering medications. This program included an outpatient visit, follow-up telephone calls, and communication about the participant's progress to his or her primary provider or cardiologist. The nurse case managers spent an average of less than five hours total per patient per year.
Patients in both groups were prescribed cholesterol-lowering medications, but Allen says the nurse case manager monitored the effectiveness of the medication, adjusted the dosage as needed, and promoted compliance in taking the medication.
Sixty-five percent of the patients in the group receiving nurse case management achieved recommended cholesterol levels, compared to 35 percent in the group receiving minimal intervention. Patients in the nurse-managed group also reported healthier diet and exercise patterns.
"Our research suggests that more aggressive treatment is needed to enable patients with a history of heart disease to manage their cholesterol, improve their health, and avoid complications," says Allen. "Further research on the long-term clinical outcomes and the cost-effectiveness of nurse case management is under way, but the results are promising. "
The study was funded by the National Institute of Nursing Research at the National Institutes of Health. Other authors are Roger S. Blumenthal, MD; Simeon Margolis, MD, PhD; Deborah Rohm Young, PhD; Edgar R. Miller III, MD, PhD; and Kathleen Kelly, BS, CRNP, all of Johns Hopkins School of Medicine.
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