Cardiovascular risk estimation by professionally active cardiovascular nurses: Results from the Basel 2005 Nurses Cohort
Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands. European Journal of Cardiovascular Nursing
(Impact Factor: 1.88).
01/2007; 5(4):258-63. DOI: 10.1016/j.ejcnurse.2006.06.007
Nurses play a key role in the prevention of cardiovascular disease (CVD) and one would, therefore, expect them to have a heightened awareness of the need for systematic screening and their own CVD risk profile. The aim of this study was to examine personal awareness of CVD risk among a cohort of cardiovascular nurses attending a European conference.
Of the 340 delegates attending the 5th annual Spring Meeting on Cardiovascular Nursing (Basel, Switzerland, 2005), 287 (83%) completed a self-report questionnaire to assess their own risk factors for CVD. Delegates were also asked to give an estimation of their absolute total risk of experiencing a fatal CVD event in the next 10 years. Level of agreement between self-reported CVD risk estimation and their actual risk according to the SCORE risk assessment system was compared by calculating weighted Kappa (kappa(w)).
Overall, 109 responders (38%) self-reported having either pre-existing CVD (only 2%), one or more markedly raised CVD risk factors, a high total risk of fatal CVD (> or =5% in 10 years) or a strong family history of CVD. About half of this cohort (53%) did not know their own total cholesterol level. Less than half (45%) reported having a 10-year risk of fatal CVD of <1%, while 13% reported having a risk > or =5%. Based on the SCORE risk function, the estimated 10-year risk of a fatal CVD event was <1% for 96% of responders: only 2% had a > or =5% risk of such an event. Overall, less than half (46%) of this cohort's self-reported CVD risk corresponded with that calculated using the SCORE risk function (kappa(w)=0.27).
Most cardiovascular nurses attending a European conference in 2005 poorly understood their own CVD risk profile, and the agreement between their self-reported 10-year risk of a fatal CVD and their CVD risk using SCORE was only fair. Given the specialist nature of this conference, our findings clearly demonstrate a need to improve overall nursing awareness of the role and importance of systematic CVD risk assessment.
Available from: Glyn Elwyn
- "Some studies had a lot of missing data on the risk factors required to assessing the quality of the CVD risk calculation (McManus et al., 2002; Montgomery et al., 2000; Peters et al., 1999). In addition, studies used data based on patient records for the calculations, and the health care professionals involved estimated the risks specifically in the context of the study or not during consultation hours, which means that the studies assessed competence rather than performance (McManus et al., 2002; Peters et al., 1999; Scholte op Reimer et al., 2006). "
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ABSTRACT: BACKGROUND: Practice nurses play an increasingly important role in the prevention of cardiovascular diseases but we do not have evidence about the accuracy of their cardiovascular risk assessments during real practice consultations. OBJECTIVES: To examine how nurses perform with regard to absolute 10-year cardiovascular risk assessment in actual practice. DESIGN: Cross-sectional study. SETTING: This study was nested in the IMPALA study, a clustered randomised controlled trial involving 24 general practices in The Netherlands. PARTICIPANTS: 24 practice nurses, trained in 10-year cardiovascular risk assessment, calculated the risk of a total of 421 patients without established cardiovascular diseases but eligible for cardiovascular risk assessment. METHODS: The main outcome measure was the accuracy of risk assessments, defined as (1) the difference between the 10-year cardiovascular risk percentage calculated by nurses and an independent assessor, and (2) the agreement between the treatment categories assigned by the nurses (low, moderate or high risk) and those assigned by the independent assessor. RESULTS: Thirty-one (7.4%) of the calculated risk percentages differed by more than our preset limits, 25 (81%) being underestimations. Elderly patients (OR 1.1, 95% CI 1.0-1.1), male patients (vs. female OR 3.1, 95% CI 1.2-7.3), and smoking patients (vs. non-smoking OR 3.8, 95% CI 1.7-8.9) were more likely to have their cardiovascular risk miscalculated. Ten (28%) of the 36 patients who should be assigned to the high-risk treatment category according to the independent calculation, were missed as high-risk patients by the practice nurses. CONCLUSIONS: The overall standard of accuracy of cardiovascular risk assessment by trained practice nurses in actual practice is high. However, a significant number of high-risk patients were misclassified, with the probability that it led to missed opportunities for risk-reducing interventions. As cardiovascular risk assessments are frequently done by nurses in general practice, further specific training should be considered to prevent undertreatment.
Available from: Ana Luisa Papoila
- "The following risk factors are integrated in SCORE charts: gender, age, smoking, systolic blood pressure, diabetes and cholesterol (total cholesterol or cholesterol/ HDL ratio) (Conroy et al. 2003). Published studies with the same objectives and using the SCORE system for low-risk countries are scarce, and they are performed in very specific populations (obese hypertensive patients, nurses)(Schindler et al. 2007; Scholte op Reimer et al. 2006). A literature review was undertaken, and no published studies using SCORE® system performed on the Portuguese population were found. "
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Cardiovascular diseases (CVD) are the leading cause of mortality in European countries. This study aimed at estimating the 10-year risk of fatal CVD in Portuguese adults and to assess the prevalence of major cardiovascular risk factors, according to the SCORE® risk prediction system.
Subjects and methods
A cross-sectional survey was carried out in 60 community pharmacies (CP) from October 2005 to January 2006 in a sample of CP users (≥40 and ≤65 years). Data were collected by patient interviews using a structured questionnaire applied by a trained pharmacist.
A total of 1,043 individuals were enrolled in the study (participation rate: 91%). The mean age was 53.7 years (SD: 7.1) with a ratio men/women of 0.68. The average risk in the sample was 1.94 (minimum 0, maximum 28, SD =2.69). About 20% of the studied adults were at high risk, of which 39.4% were asymptomatic. CV risk was significantly higher in the oldest age group and in men (p < 0.05). The prevalence of main CV risk factors was: hypertension-54.8%; hypercholesterolemia-63.1%, diabetes-13.4%; smoking-10.4% and obesity–29.0%. About 1/3 of those asked had family history of premature CVD. Mean values of biochemical and clinical parameters were: systolic blood pressure (mmHg): 134.8 ± 19.7; diastolic blood pressure (mmHg): 81.0 ± 11.4; total cholesterol (mg/dl): 193.8 ± 34.6; body mass index (kg/m2): 28.0 ± 4.5.
According to SCORE®, about one-fifth of the individuals was classified as high risk, and 7.7% was asymptomatic. CV risk was significantly higher in the oldest age group (55–65 years old) and in men (p < 0.05). These results show a high prevalence of some risk factors, particularly hypertension and hypercholesterolemia.
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ABSTRACT: A treatment gap exists between published guidelines for secondary prevention of cardiovascular disease and application of these guidelines in clinical practice. The "Get With The Guidelines" program is a quality initiative developed by the American Heart Association to help acute care providers bridge this gap, thereby decreasing morbidity and mortality from cardiovascular disease. This article describes how cardiac rehabilitation nurses successfully implemented the program using a prospective case-management model in the acute care setting. An overview of the program including purpose, benefits, tools, and resources is provided along with start-up considerations, potential barriers, training needs, and keys to success.
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