Specialist nurses are just as well-equipped to carry out follow-up appointments for heart attack patients’ post-recovery, according to new research from NZ.
The study, published 7 October 2022 in the New Zealand Medical Journal, examined more than 5,000 New Zealanders who survived a cardiac event between 2010 and 2018, and found that those who attended a follow-up appointment with a qualified, well-supported nurse fared just as well as those seen by a cardiologist.
The nurse-led clinic model also had shorter wait times, allowing nurses to address patients’ barriers to recovery, lifestyle adjustments, and medication adherence early on, while encouraging engagement with their primary care team.
Lead author, Professor Andrew Kerr from the University of Auckland, and Middlemore Hospital said that overall, the nurse-led model was associated with earlier access to follow-up, was equally as effective at maintaining secondary prevention pharmacotherapy and resulted in similar survival and readmission rates with non-fatal acute coronary syndrome (ACS), stroke or heart failure.
“The early recovery period following ACS is important, with a higher risk of mortality and recurrent events requiring a focus on prevention, including primary care follow-up, cardiac rehabilitation, support around lifestyle change and evidence-based pharmacological interventions,” Professor Kerr explained.
“However, despite a focus on system improvements over the years, in our own department, timely access to cardiologist outpatient care remained an issue and new models of care have been introduced.
“These include several interventions led by clinical nurse specialists and nurse practitioners to support patients to better understand and manage their cardiac condition, address service gaps due to high demand or workforce shortages and support patient outcomes following discharge.”
He said that before 2010, all patients discharged from Middlemore Hospital after ACS were followed up by a consultant cardiologist or supervised registrar yet increasing demand and long waiting times for outpatient review led to funding for a nurse-led post-ACS follow-up clinic model, mentored by a senior cardiologist.
The nurses leading this service were experienced in cardiology, cardiac rehabilitation, and long-term condition support, and local audits identified that patients managed in the nurse-led clinics were more likely to be prescribed preventative therapies and individualised lifestyle advice such as, smoking cessation support, exercise guidance and dietary advice – compared to usual care.
“However, it was important that we demonstrated these interventions delivered outcomes that were as effective as medical-only models of care before we promoted nurse-led models more widely,” Professor Kerr said.
“A frequent impediment to developing new nurse clinics is that the growing body of nurse-led literature is often classed as low-level evidence with a highly selected patient cohort and a heterogenous evidence base.
“Between 2010 to 2018, we identified 5,296 NZ residents, eligible for outpatient follow-up, who were discharged alive following a first ACS event. Of these 4395 (83%) had a follow-up with a clinician, of whom 1,161 (26%) had their first follow-up via a medical model, and 3234 (74%) used the nurse-led model.”
Over the course of the study there were no differences between the two cohorts, one year after being discharged, in all-cause mortality, rehospitalisation for either MI, stroke, or heart failure, or a composite endpoint of all-cause mortality and/or rehospitalisation for MI/stroke/HF.
Similarly, in terms of dispensing important secondary prevention pharmacotherapies, there were no important differences between patients followed up in the medical or the nurse-led model of care, even though the rate of dispensation was generally high at the point of discharge.
“Cardiac rehabilitation offers support for people as they resume their lives, however, many do not take up this evidenced-based support for a variety of reasons,” the authors concluded.
“Most people, however, do attend the outpatient follow up review in traditionally medical clinics [and] this is the first study to prove that suitably qualified and supported nurses can provide effective and timely outpatient care, as safely as their medical colleagues.”