TY - JOUR
T1 - Nurse case management of hypercholesterolemia in patients with coronary heart disease
T2 - Results of a randomized clinical trial
AU - Allen, Jerilyn K.
AU - Blumenthal, Roger S.
AU - Margolis, Simeon
AU - Young, Deborah Rohm
AU - Miller, Edgar R.
AU - Kelly, Kathleen
N1 - Funding Information:
Supported by grant NR00044 from the National Institute of Nursing Research, NIH, and NIH grants RR00035 and RR00722 to the General Clinical Research Center and the Johns Hopkins University School of Medicine.
PY - 2002/10/1
Y1 - 2002/10/1
N2 - Background: Despite the large body of evidence confirming the effectiveness of lipid lowering for the secondary prevention of coronary heart disease (CHD) events, undertreatment of hyperlipidemia is common. This study tested the effectiveness of a nurse case management program to lower blood lipids in patients with CHD. Methods: A total of 228 consecutive, eligible adults with hypercholesterolemia and CHD were recruited during hospitalization after coronary revascularization. Patients were randomized to receive lipid management, including individualized lifestyle modification and pharmacologic intervention, from a nurse practitioner for 1 year after discharge in addition to their usual care (NURS), or to usual care enhanced with feedback on lipids to their primary provider and/or cardiologist (EUC). Results: Significantly more patients in the NURS group than in the EUC group achieved low-density lipoprotein cholesterol (LDL-C)levels <2.59 mmol/dL (100 mg/dL, 65% vs 35%, P = .0001). Favorable changes in lipids and lipoproteins were accompanied by significant improvements in dietary and exercise patterns in the NURS group. In a multivariate analysis adjusting for other covariates, being assigned to the NURS group (P = .0001) and being on a lipid-lowering medication (P = .001) were significant independent predictors of LDL-C level. Conclusions: Control of hypercholesterolemia in patients who have undergone coronary revascularization can be improved by a nurse case-management program. Because the National Cholesterol Education Program Adult Treatment Panel III guidelines have broadened the definition of high-risk populations that warrant aggressive treatment, nurse case-management programs may offer key opportunities to enhance appropriate application of new treatment paradigms.
AB - Background: Despite the large body of evidence confirming the effectiveness of lipid lowering for the secondary prevention of coronary heart disease (CHD) events, undertreatment of hyperlipidemia is common. This study tested the effectiveness of a nurse case management program to lower blood lipids in patients with CHD. Methods: A total of 228 consecutive, eligible adults with hypercholesterolemia and CHD were recruited during hospitalization after coronary revascularization. Patients were randomized to receive lipid management, including individualized lifestyle modification and pharmacologic intervention, from a nurse practitioner for 1 year after discharge in addition to their usual care (NURS), or to usual care enhanced with feedback on lipids to their primary provider and/or cardiologist (EUC). Results: Significantly more patients in the NURS group than in the EUC group achieved low-density lipoprotein cholesterol (LDL-C)levels <2.59 mmol/dL (100 mg/dL, 65% vs 35%, P = .0001). Favorable changes in lipids and lipoproteins were accompanied by significant improvements in dietary and exercise patterns in the NURS group. In a multivariate analysis adjusting for other covariates, being assigned to the NURS group (P = .0001) and being on a lipid-lowering medication (P = .001) were significant independent predictors of LDL-C level. Conclusions: Control of hypercholesterolemia in patients who have undergone coronary revascularization can be improved by a nurse case-management program. Because the National Cholesterol Education Program Adult Treatment Panel III guidelines have broadened the definition of high-risk populations that warrant aggressive treatment, nurse case-management programs may offer key opportunities to enhance appropriate application of new treatment paradigms.
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U2 - 10.1016/S0002-8703(02)00141-2
DO - 10.1016/S0002-8703(02)00141-2
M3 - Article
C2 - 12360165
AN - SCOPUS:0036791247
SN - 0002-8703
VL - 144
SP - 678
EP - 686
JO - American heart journal
JF - American heart journal
IS - 4
ER -