Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (a chest pain evaluation in the emergency room [CHEER] substudy)

Thomas G. Allison, Michael E. Farkouh, Peter A. Smars, Roger W. Evans, Ray W. Squires, Sherine E. Gabriel, Stephen L. Kopecky, Raymond J Gibbons, Guy S. Reeder

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

This study examined whether nurses could manage coronary risk factors in patients with unstable angina more effectively than physicians practicing usual care. Three hundred twenty-six patients were randomized in the emergency room to a 6-month program of risk factor management by a registered nurse versus participation in usual care. The nurse intervention consisted of a 30-minute counseling visit at 6 to 10 days after the chest pain episode and a second 30-minute session 1 month later. Multiple risk factors were assessed and addressed: smoking, blood lipids, blood pressure, blood glucose, physical inactivity, weight, psychological stress, and social isolation. Compared with usual care, nurse intervention patients significantly reduced both triglycerides (-29 ± 8 vs 5 ± 6 mg/dl; p <0.0004) and weight (-0.9 ± 3.3 vs +0.1 ± 2.1 kg; p = 0.0071), and had corresponding improvements in self-reported diet compliance and exercise (+34 ± 106 vs +9 ± 98 minutes, p = 0.0491). No significant differences between groups were observed in terms of 6-month changes in total, high-density lipoprotein, or low-density lipoprotein cholesterol, blood pressure, fasting blood glucose, percent body fat or waist-hip ratio, or psychological distress scores. The 6-month rate of recurrent events (cardiac death, out-of-hospital cardiac arrest, myocardial infarction) and/or revascularizations (coronary artery bypass surgery or coronary angioplasty) was lower in the nurse intervention group (1% vs 9%; p = 0.002). We conclude that a nurse-delivered risk factor intervention program for patients with chest pain is feasible and more effective than usual care in terms of fostering lifestyle changes that may lower coronary risk. Copyright (C) 2000 Excerpta Medica Inc.

Original languageEnglish (US)
Pages (from-to)133-138
Number of pages6
JournalAmerican Journal of Cardiology
Volume86
Issue number2
DOIs
StatePublished - Jul 2000

Fingerprint

Unstable Angina
Chest Pain
Hospital Emergency Service
Patient Care
Nurses
Blood Glucose
Blood Pressure
Out-of-Hospital Cardiac Arrest
Weights and Measures
Social Isolation
Myocardial Revascularization
Foster Home Care
Waist-Hip Ratio
Risk Management
HDL Lipoproteins
Angioplasty
Psychological Stress
Coronary Artery Bypass
LDL Cholesterol
Compliance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (a chest pain evaluation in the emergency room [CHEER] substudy). / Allison, Thomas G.; Farkouh, Michael E.; Smars, Peter A.; Evans, Roger W.; Squires, Ray W.; Gabriel, Sherine E.; Kopecky, Stephen L.; Gibbons, Raymond J; Reeder, Guy S.

In: American Journal of Cardiology, Vol. 86, No. 2, 07.2000, p. 133-138.

Research output: Contribution to journalArticle

Allison, Thomas G. ; Farkouh, Michael E. ; Smars, Peter A. ; Evans, Roger W. ; Squires, Ray W. ; Gabriel, Sherine E. ; Kopecky, Stephen L. ; Gibbons, Raymond J ; Reeder, Guy S. / Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (a chest pain evaluation in the emergency room [CHEER] substudy). In: American Journal of Cardiology. 2000 ; Vol. 86, No. 2. pp. 133-138.
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AB - This study examined whether nurses could manage coronary risk factors in patients with unstable angina more effectively than physicians practicing usual care. Three hundred twenty-six patients were randomized in the emergency room to a 6-month program of risk factor management by a registered nurse versus participation in usual care. The nurse intervention consisted of a 30-minute counseling visit at 6 to 10 days after the chest pain episode and a second 30-minute session 1 month later. Multiple risk factors were assessed and addressed: smoking, blood lipids, blood pressure, blood glucose, physical inactivity, weight, psychological stress, and social isolation. Compared with usual care, nurse intervention patients significantly reduced both triglycerides (-29 ± 8 vs 5 ± 6 mg/dl; p <0.0004) and weight (-0.9 ± 3.3 vs +0.1 ± 2.1 kg; p = 0.0071), and had corresponding improvements in self-reported diet compliance and exercise (+34 ± 106 vs +9 ± 98 minutes, p = 0.0491). No significant differences between groups were observed in terms of 6-month changes in total, high-density lipoprotein, or low-density lipoprotein cholesterol, blood pressure, fasting blood glucose, percent body fat or waist-hip ratio, or psychological distress scores. The 6-month rate of recurrent events (cardiac death, out-of-hospital cardiac arrest, myocardial infarction) and/or revascularizations (coronary artery bypass surgery or coronary angioplasty) was lower in the nurse intervention group (1% vs 9%; p = 0.002). We conclude that a nurse-delivered risk factor intervention program for patients with chest pain is feasible and more effective than usual care in terms of fostering lifestyle changes that may lower coronary risk. Copyright (C) 2000 Excerpta Medica Inc.

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