Article: Providing cardiovascular risk management information to acute coronary syndrome patients: A randomized trial.[show abstract] [hide abstract]
ABSTRACT: Objectives. Cardiac patients have been shown to have inaccurate understanding of their cardiovascular risk. The purpose of the study was to investigate whether a guideline-based risk assessment and management intervention could facilitate understanding of cadiovascular risk and appropriate illness perceptions in cardiac patients. Design. Randomized trial. Methods. A total of 106 patients with MI or unstable angina were randomized to receive standard care with or without a 30-min nurse-led computerized Predict CVD-Diabetes (where CVD is cardiovascular disease) session. Patients' risk perceptions (using categorical and numerical measures), and perceptions of their heart condition were assessed at admission, discharge, and 3 months. Results. The intervention group rated the risk information as more easily understood than the control group. At discharge, they had increased perceptions of personal control, higher perceptions that a low-fat diet and regular exercise could help their condition, and believed their current illness would be shorter compared to the control group. At 3 months, no group differences were significant. The intervention had no effect on risk perceptions, which were high in both groups. Patients' perceptions of 'high' risk corresponded to numerical estimates of over 50%, which differs from clinical guidelines (over 20%). Conclusions. A computerized cardiovascular risk assessment and management session can help acute coronary syndrome patients understand CVD risk information and improve perceptions of control in the short term, but not change risk perceptions. In-hospital risk factor assessment and management information may help patients understand the importance of key lifestyle changes. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT?: • Many members of the public, as well as patients with diagnosed coronary heart disease (CHD), have poor understanding of their cardiovascular disease risk. • Giving risk information can improve accuracy of risk perceptions, and may increase intentions to start preventive risk reduction treatments but more research is needed with patients with established CHD. WHAT DOES THIS STUDY ADD?: • Providing acute coronary syndrome patients with individualised risk assessment and risk management information may be beneficial over the short term by increasing patients' perceptions of control and the importance of key lifestyle changes. • A difficulty in communicating cardiovascular risk levels is the poor correspondence between patients' understanding of very high risk and the clinical definition of very high risk.British Journal of Health Psychology 06/2012; · 2.70 Impact Factor
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ABSTRACT: Patients with gout are at high risk for cardiovascular disease (CVD), and this risk is frequently under-managed. To evaluate a nurse-led multidisciplinary approach to improve CVD risk management in patients with gout. Patients referred to rheumatology clinics for gout management received a structured nurse-led CVD risk assessment. For the patients with an initial 5 year risk >10%, interventions for CVD prevention were identified and goals developed. These patients were then reassessed approximately 6 months later to determine changes in CVD risk management and profile. Of 210 patients with gout, 73% had either a 5-year CVD risk >10% or had known CVD. Of these higher risk patients, 84% were available for follow-up. Compared with the initial visit there were improvements at follow-up in: the prescription of aspirin, statins, nicotine replacement therapy, uptake of self-reported activity levels, mean systolic and diastolic blood pressure, with a trend towards reduced cigarette smoking. A nurse-led intervention to assess and manage cardiovascular risk in patients with gout is effective in improving uptake of preventative interventions.European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 06/2011; 10(2):94-100.
Article: Does Your Heart Forecast help practitioner understanding and confidence with cardiovascular disease risk communication?[show abstract] [hide abstract]
ABSTRACT: Explaining what cardiovascular disease (CVD) risk means and engaging in shared decision-making regarding risk factor modification is challenging. An electronic CVD risk visualisation tool containing multiple risk communication strategies (Your Heart Forecast) was designed in 2009. To assess whether this tool facilitated explaining CVD risk to primary care patients. Health professionals who accessed a Primary Health Organisation website or who attended educational peer groups over a three-month period were invited to complete questionnaires before and after viewing a four-minute video about the tool. Respondents were asked to make an informed guess of the CVD risk of a 35-year-old patient (actual CVD risk 5%) and rate the following sentence as being true or false: 'If there were 100 people like Mr Andrews, five would go on to have a cardiac event in the next five years.' They also were asked to rank their understanding of CVD risk and confidence in explaining the concept to patients. Fifty health professionals (37 GPs, 12 practice nurses, one other) completed before and after questionnaires. Respondents' CVD risk estimates pre-video ranged from <5% to 25% and nine rated the sentence as being false. After the video, all respondents answered these questions correctly. Personal rankings from zero to 10 about understanding CVD risk and confidence in explaining risk reduced in range and shifted towards greater efficacy. Whether this tool facilitates discussions of CVD risk with patients and improves patient understanding and lifestyle behaviour needs to be evaluated in a randomised trial.Journal of primary health care 01/2011; 3(1):4-9.
Article: Acute Predict: a clinician-led cardiovascular disease quality improvement project (Predict-CVD 12).[show abstract] [hide abstract]
ABSTRACT: New Zealand data demonstrate major disparities in cardiovascular health, particularly by ethnicity and socioeconomic deprivation. ACUTE PREDICT AIM: Acute Predict, the secondary care arm of primary care based PREDICT, is a multidisciplinary project based in the coronary care unit, and is jointly led by nursing and medical staff. The project aim is to ensure patients with acute coronary syndromes (ACS) receive appropriate evidence-based secondary prevention management short- and long-term, regardless of age, socioeconomic status or ethnicity. Acute Predict utilises an electronic backbone to provide the following (1) guideline-based patient-specific decision support, (2) data collection as part of routine clinical workflow, (3) linkage of patients to cardiac rehabilitation and primary care chronic care management programs, (4) clinical and management data capture, (5) real-time whole group and sub-group Key Performance Indicators reporting with drill-down to individual patient data, and (6) long-term tracking of individual patient outcome via linkage to national databases. Over the four years of the project in-hospital provision of cardiac rehabilitation has improved and appropriate discharge medication is high. There are no differences according to ethnicity. Despite this, Maori patients in the Acute Predict ACS cohort are twice as likely as Europeans to have recurrent events post-discharge, even after adjustment for known risk factors. The built-in real-time data reporting and outcomes/prescribing linkage facilitate monitoring of the quality of CVD prevention activity across the continuum of care. It allows early identification of treatment gaps and of persistent disparities in outcome in our patients. We are learning how best to use this real-time data collection and reporting to support the design and assessment of targeted interventions to close gaps and reduce disparity.Heart Lung & Circulation 04/2010; 19(5-6):378-83. · 1.20 Impact Factor
Article: Equity of access to CVD risk management using electronic clinical decision support in the coronary care unit.[show abstract] [hide abstract]
ABSTRACT: Cardiovascular (CVD) risk management post myocardial infarction is inconsistently delivered with those who need the most receiving the least - the 'inverse care law.' The Acute PREDICT Initiative is a nurse led computerised decision support system (CDSS), to provide point-of-care guideline-based, patient-specific CVD risk management recommendations to all. All patients admitted to Middlemore Hospital CCU over 2 years with acute CVD-related events potentially 'eligible' for PREDICT assessment were identified. Age, gender, ethnicity and a small area measure of socioeconomic status (NZDep01) were assessed. 1813/2246 (81%) of people admitted were eligible for a PREDICT assessment. Of those, 973 (54%) received a complete assessment. There were no important differences by quintile of deprivation or ethnicity between the patients receiving PREDICT and the rest. PREDICT assessments were less likely for the elderly (35.7% of >75years compared with 57.7% of <75years), for women (47.1% of women and 56.5% of men), and for those who had 5 or more previous admissions. Patients potentially at higher risk because of their ethnic or socioeconomic background received equitable access to in-hospital CVD risk management post MI using PREDICT. However, some other high-risk groups under-utilised the system.European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 02/2010; 9(4):233-7.