A nurse-led cardiovascular disease prevention clinic

Abstract

Background: Patients who present to our hospital with a vascular event receive appropriate preventative measures and are discharged to Primary Care without further specialist review. We have initiated a Cardiovascular Disease Prevention Clinic to provide specialist review for all patients at one year following their index event. Purpose: This project was undertaken to assess the implementation of guideline-directed preventative treatment within our current patient pathway, thereby establishing the need for, and the likelihood of benefiting from a secondary care specialist clinic. Methods: The medical notes of all patients on our angiography database over a 6 month period were scrutinised. This included the majority of patients diagnosed with acute coronary syndromes [ACS] and symptomatic coronary artery disease [CAD] over this period. Patients with confirmed atheromatous CAD were screened for clinical features that would put them at high risk of recurrent events. These risk factors were identified in recent landmark trials[1,2] and include: diabetes, eGFR <60, age >65 years, multi-vessel disease, recurrent events within 3 years, and heart failure. Of the high risk patients, those whose management was deemed suboptimal were invited to attend the clinic that is nurse led, protocol driven, with a Consultant available for advice. All appointments were conducted via telephone in view of COVID precautions. Patients were assessed according to guideline targets for cardiovascular risk factors[3,4,5]. Lifestyle habits were reviewed with appropriate guidance provided for the patient. Results: 833 patients were screened, of which 175 patients fulfilled the above criteria and so invited to the clinic. 2 patients declined the appointment. Table 1 summarises the guideline targets not achieved by the high risk cohort. 132 patients (75.8%) met the criteria for consideration for DOAC[6]. Of these, 80 (60%) had a relative bleeding contraindication or declined therapy. 155 (88.6%) met the criteria for consideration for longer-term P2Y12i[7]. Of these 139 (89.7%) had relative bleeding contraindications or declined therapy. Interventions implemented at this clinic are summarised in Table 2. All patients were given advice with regard to lifestyle modification strategies. Conclusion: The discharge pathway for patients diagnosed with ACS and symptomatic CAD includes cardiologist prescribing, cardiac rehabilitation nurse review and primary care follow-up. Despite this, we showed that a significant number of patients with CAD and at high risk of recurrent events failed to achieve secondary prevention targets at one year following their index event. A specialist CVD prevention follow-up clinic can result in significant improvements in patient management over and above the usual standard of care and we should anticipate a reduction in cardiovascular events as a result of this. A nurse led clinic with prescribing protocols based on current guidelines is a successful clinic model. (Figure Presented).