Effectiveness of nurse-led clinics for patients with coronary heart disease: a systematic review and meta-analysis

Abstract

Aims: Nurse-led clinics can potentially provide effective secondary prevention for coronary heart disease (CHD). This study updated an existing systematic review to determine the effectiveness of nurse-led clinics for patients with CHD on mortality, morbidity and other clinical and patient outcomes. Methods and results: This review of randomized controlled trials used Joanna Briggs Institute methodology, RoB 2 for critical appraisal, RevMan software for synthesis, GRADE for certainty of evidence, and PRISMA for reporting. Twenty-nine trials of nurse-led clinics compared with usual care by another healthcare professional for adults with existing or newly diagnosed CHD (e.g. angina pectoris and myocardial infarction) were included. Nurse-led clinics probably result in little to no difference in mortality (RR 0.91, 95% CI 0.59–1.40; P = 0.67; I2 = 43%; six studies, 3921 participants; moderate certainty evidence) and a slight reduction in CHD exacerbations (RR 0.87, 95% CI 0.76–0.99; P = 0.03; I2 = 40%; five studies, 2848 participants; moderate certainty evidence). Risk factors including systolic and diastolic blood pressure (low certainty) and total cholesterol (moderate certainty) were probably slightly decreased in NLCs although there was no difference in high density lipoprotein (low certainty) between the groups. Low-moderate certainty evidence for behavioural outcomes (exercise and smoking), adherence to medications (Beta blockers, ACE inhibitors, statins and antiplatelets), health-related quality of life (both physical and mental health) and depression and anxiety indicates that patient outcomes are better than, or at least no worse than, usual care. Conclusion: Treatment in nurse-led clinics for secondary prevention of CHD is supported by the best available evidence. Registration: PROSPERO (CRD42020205270).