How effective is a nurse-led follow-up clinic for patients post Percutaneous Coronary Intervention (PCI)?

Abstract

Background: The nurse-led PCI follow-up service has been in operation since 2001. All patients undergoing PCI are followed up in the clinic for one year following a set protocol, by either nurse specialists or a nurse consultant. Appointments are carried out in clinic or via the telephone. The patient's clinical status, risk factors and medication are reviewed. Purpose: To determine the efficacy of a nurse-led follow-up service for patients post PCI. Method: This retrospective audit covers the period January-December 2012. Data from all patients reviewed in the clinic were prospectively entered onto a database. Results: A total of 2547 appointments were carried out. 1728 appointments were for primary PCI patients (67.84%), 245 were for emergency PCI (9.62%), 406 for elective PCI (15.94%) and the remaining for rescue PCI or in-stent restenosis (167 = 6.55%). Three-quarters of the appointments were carried out in the out-patient clinic (72.24%) and the remainder via the telephone (27.76%). 508 patients were followed up at 1 month (19.95%), 238 at 6 months (9.34%), 395 at 1 year (15.51%) and 1211 (47.55%) were seen in-between these appointment times. The remaining 195 patients were seen at 2-5 years (7.66%). At review, the majority of patients had no angina (74.60%) and for 1870 (73.42%) their activity was not limited by breathlessness. Medication compliance was good. At 1 month 95.87% of patients were taking Aspirin, 96.85% were taking Clopidogrel, Prasugrel or Ticagrelor, 95.28% were taking a statin, 81.10% were taking a beta-blocker and 77.56% were taking an ACEi or ARB. The figures at 1 year were 92.15% for Aspirin, 79.75% for Clopidogrel, Prasugrel or Ticagrelor, 92.66% for statin, 77.97% for beta-blockers and 77.72% for ACEi or ARB. At 1 year, 83.04% of patients were not smoking, 66.84% had a systolic BP of <140mm/Hg and 84.05% had a diastolic BP of <90mm/Hg. Patient satisfaction with the clinic was also audited in September 2012. 55 patients completed questionnaires in the clinic. 96.36% were happy to be reviewed by the nurses, 98.18% were happy with the length of the clinic appointment and 98.18% found the nurses approachable. 98.18% felt that the nurses had sufficient knowledge to conduct the appointment and 94.55% found attending the clinic a satisfying experience. Conclusion: Suitably trained nurses can successfully run a follow-up service for patients post PCI, achieving a high level of patient satisfaction. The nurse-led clinics enable uniform assessment of the patient's medical condition and risk factor status and optimization of secondary prevention.