A randomized, controlled trial for risk factor reduction in patients with symptomatic vascular disease: the multidisciplinary Vascular Prevention by Nurses Study (VENUS).
ABSTRACT Patients with manifest vascular disease are at high risk of a new vascular event or death. Modification of classical risk factors is often not successful. We determined whether the extra care of a nurse practitioner could be beneficial to the cardiovascular risk profile of high-risk patients.
We conducted a randomized, controlled trial based on the Zelen design.
Two hundred and thirty-six patients with manifestations of a vascular disease and who had two or more modifiable vascular risk factors were pre-randomized to receive treatment by a nurse practitioner plus usual care or usual care alone. After 1 year, risk factors were remeasured. The primary endpoint was achievement of treatment goals for blood pressure, lipid, glucose and homocysteine levels, body mass index, and smoking.
Of the pre-randomized patients, 95 of 119 (80%) in the intervention group and 80 of 117 (68%) in the control group participated in the study. After a mean follow-up of 14 months, the patients in the intervention group achieved significantly more treatment goals than did the patients in the control group (systolic blood pressure 63 versus 37%, total cholesterol 79 versus 61%, low density lipoprotein-cholesterol 88 versus 67%, and body mass index 38 versus 24%). Medication use was increased in both groups and no differences were found in patients' quality of life (SF-36) at follow-up.
Treatment delivered by nurse practitioners, in addition to a vascular risk factor screening and prevention program, resulted in a better management of vascular risk factors than usual care alone in vascular patients after 1-year follow-up.
Article: A pilot-study to identify the feasibility of an Internet-based coaching programme for changing the vascular risk profile of high-risk patients.[show abstract] [hide abstract]
ABSTRACT: To evaluate the feasibility of a web-based coaching programme for vascular risk factor treatment, to describe the patterns of use and to measure changes in risk factors. Patients with a clinical manifestation of arterial disease and Internet access were asked to participate in the nurse-led Internet-based risk factor management programme. At the first clinic visit, a personalized action plan was made for the treatment of risk factors. Patients were instructed on communication with a specialized nurse through Internet and encouraged to enter self-measured risk factor levels at their personalized website. The nurse practitioner replied on working days and gave feedback, support, and recommendations on lifestyle and medical treatment. After 6 months, risk factors were re-measured. Fifty patients participated, 70% were overweight, 64% had hypertension, 42% hyperlipidemia, and 24% smoked at baseline. During 6 months, the log-in average at the individual website was 35 times per patient (1.3 log-ins/week); while the nurse practitioner logged-in at the overall website 23 times/week. The website was hardly used by five patients. Most e-mail messages were sent by patients for hypertension (211 times) and obesity (203 times), whereas the nurse practitioner sent nearly twice as many e-mail messages for hypertension (400 times) and obesity (455 times). The level of most risk factors decreased and the fraction of achieved treatment goals increased (blood pressure from 36 to 58%, LDL-cholesterol from 58 to 64%, glucose from 64 to 82%). A web-based vascular risk factor intervention programme is feasible; it is frequently used by patients and suitable to decrease the level of several risk factors. It has the promise of being an efficacious intervention for risk factor sanitation in patients with symptomatic vascular disease. An Internet-based individualised risk management programme could make patients aware of their self-management capability and may contribute to risk factor reduction.Patient Education and Counseling 10/2008; 73(1):67-72. · 2.31 Impact Factor