Nurses' perspectives on nurse-coordinated prevention programmes in secondary prevention of cardiovascular disease: a pilot survey

Figures & data

Box 1. Summary of nurse interventions in RESPONSE trial – per modifiable risk factor

Risk factor	Intervention	Target	Measurement
Smoking	Counselling/support with use of educational material	Smoking cessation	Self-reported
Physical activity	Counselling/support with use of educational material	≥30 min 5×/week minimal intensity equivalent to brisk walk	Self-reported
Weight/fat distribution	Counselling/support with use of educational material	♂: BMI ≤ 25 kg/m² or waist circumference <94 cm ♀: BMI ≤ 25 kg/m² or waist circumference <80 cm	Height/weight Waist circumference
Hypertension	Active screening Counselling/support with use of educational material Referral to treating specialist if outside target range	SBP < 140 mmHg	Blood pressure Right/Left arm
Dyslipidaemia	Active screening Counselling/support with use of educational material Referral to treating specialist if outside target range	LDL ≤ 2.5 mmol/l HDL ≥ 1.0 mmol/l TG ≥ 2.0 mmol/l	Fasting venous blood sample: TC, LDL, HDL,TG
Antithrombotic therapy	Interview about compliance	Maximum adherence to treatment	Self-reported
Medication adherence	Active screening Counselling/support with use of educational material Referral to treating specialist	Maximum adherence to treatment	Self-reported

BMI, body mass index; SBP, systolic blood pressure; LDL, low-density lipoprotein; HDL, high-density lipoprotein; TG, triglycerides; TC, total cholesterol.

Box 2. Survey categories

Questions 1–7

Trial execution and user friendliness of case report forms

Number of patients seen, use and structure of case report forms.

Experiences with standardized procedures to adjust cholesterol and blood pressure.

Questions 8–21

Nurse perceived effects of NCPP interventions on patients’ risk factor profile

Estimation of success in achieving target values for blood pressure, cholesterol, weight, diet/eating pattern, physical activity, overall risk profile and confidence in the sustainability of the achieved changes.

Questions 22–45

Process of care

General evaluation of executing RESPONSE clinic visits, strong and weak points, efficiency and effectiveness of the intervention. Willingness to work in NCPPs in the future.

Evaluation of consultations and correspondence with and availability of general practitioners and cardiologists. Did general practitioners, cardiologists listen to the ideas and advice of nurses and did they handle accordingly?

NCPP, nurse-coordinated prevention programme.

Table 1. Nurse characteristics.

Nurses (n = 15)
Median age (interquartile range)	43 years (37–49)
Male gender	25%
Nurses’ background/employment
Nurse practitioner, n (%)	3 (20)
Coronary care unit nurse, n (%)	4 (27)
Nurse + additional experience/specialisation, n (%)	2 (13)
Registered nurse, n (%)	5 (33)
Research nurse, n (%)	1 (7)
Previous experience in prevention programmes, n (%)	4 (27)

Table 2. Perceived success in achieving patients’ risk factor targets and perceived success in sustaining effects on patients’ risk factors.

	Perceived success in achieving patients’ risk factor targets			Perceived success in sustaining effects on patients’ risk factors			Observed success in on-target risk factors at 12-month follow-up^a
Risk factors	(Very) successful, n (%)	Neutral, n (%)	(Very) unsuccessful (%)	(Very) successful, n (%)	Neutral, n (%)	(Very) unsuccessful, n (%)	Difference intervention – control		p-value
Systolic blood pressure	7 (54)	4 (31)	2 (15)	5(38)	7 (54)	1 (8)	+14%		<0.001
LDL-cholesterol	7 (54)	4 (31)	2 (15)	9(69)	4 (31)	0 (0)	+10%		0.007
Body mass index	6 (46)	3(23)	4 (31)	1(8)	12 (92)	0 (0)	–6%		0.09
Smoking	8 (62)	2 (15)	3 (23)	3(23)	10 (77)	0 (0)	–2%		0.72
Medication adherence	9 (69)	4 (31)	0 (0)	9(69)	4 (31)	0 (0)	AT	+0%	0.99
							LLA	–1%	0.64
							B-blocker	–2%	0.53
							CCB	–3%	0.35
							Diuretic	+6%	0.04
							ACEI	+11%	0.005
							AT2	+0%	0.92
Healthy food choices	9 (69)	3 (23)	1 (8)	8(62)	5 (38)	0 (0)
Alcohol consumption							+2%		0.35
Fruit consumption							+9%		<0.001
Vegetable consumption							+10%		<0.001
Physical activity	7 (54)	5 (38)	1 (8)	3(23)	9 (69)	1 (8)	+14%		<0.001
Overall risk profile	10 (77)	2 (15)	1 (8)	5(38)	8 (62)	0 (0)	Not applicable

^aReporterd differences between intervention and control groups as measured in the RESPONSE trial. The differences are reported as the absolute differences of the percentage of patients in the intervention group on-target minus the percentage of patients in the control group on-target at 12-month follow-up.

LDL-cholesterol, low-density lipoprotein-cholesterol; AT, antithrombotic agent; LLA, lipid-lowering agent; CCB, calcium channel blocker; ACEI, angiotensin-converting-enzyme inhibitor; AT2, angiotensin II receptor antagonist.

Box 3. Evaluation of process of care

Beneficial effects of interventions (categorized in educational and awareness, psychological, and monitoring and feedback components) and suggestions for additional interventions and techniques

Educational component

Increasing knowledge of cardiovascular disease and risk factors

Increasing knowledge of lifestyle changes and what can be achieved with these changes

Awareness component

Raising awareness of health status

Raising awareness of what patients can do to improve their health status

Feedback on risk factor modification

Psychological component

Providing support

Reassuring patients by discussing their insecurities

Reassuring patients by providing answers to their questions

Providing extra attention

One-on-one setting

Building trust

Monitoring and feedback component

Frequent visits

Enabling immediate action to treat deviating health outcomes

Suggestions for additional interventions and techniques

Pre-screening of mental status, for example, anxiety and depression

Table 3. Collaboration with cardiologists and general practitioners.

	Cardiologist			General practitioner
	(Fully) agree, n (%)	Neutral, n (%)	(Fully) disagree, n (%)	(Fully) agree, n (%)	Neutral, n (%)	(Fully) disagree, n (%)
Sufficiently available for consultation	11 (85)	2 (15)	0 (0)	4 (31)	5 (38)	4 (31)
Listened to my advice/ideas	11 (85)	2 (15)	0 (0)	4 (31)	5 (38)	4 (31)
Acted on my advice/ideas	12 (92)	1 (8)	0 (0)	3 (23)	6 (46)	4 (31)
Positive experience collaborating with physician	12 (92)	1 (8)	0 (0)	3 (23)	6 (46)	4 (31)