The Impact of Nurse-Led Clinics on the Mortality and Morbidity of Patients with Cardiovascular Diseases: A Systematic Review and Meta-analysis

Mouaz H. Al-Mallah, Iyad Farah, Wedad Al-Madani, Bassam Bdeir, Samia Al Habib, Maureen L. Bigelow, Mohammad H Murad, Mazen Ferwana

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Abstract

BACKGROUND:: Nurse-led clinics (NLCs) have been developed in several health specialties in recent years. The aim of this analysis is to summarize and appraise the available evidence about the effectiveness of NLCs on the morbidity and mortality outcomes in patients with cardiovascular diseases (CVDs).

METHODS:: We searched Cochrane databases, MEDLINE, Web of Science, PubMed, EMBASE, Google Scholar, BIOSIS, and bibliography of secondary sources from inception through February 20, 2013. Studies were selected and data were extracted independently by 2 investigators. Eligible studies were randomized trials of NLCs of patients with CVD. Of 56 potentially relevant articles screened initially, 12 trials met the inclusion criteria. The outcomes of interest were all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, major adverse cardiac events, revascularization, lipids control, and adherence to antiplatelet medications. We performed random-effects meta-analysis to estimate summary risk ratios and quantified between-studies heterogeneity with the I statistic.

RESULTS:: The 12 trials allocated 4886 patients to NLCs and 4954 patients to usual care. The NLC patients had decreased all-cause mortality (odds ratio, 0.78; 95% confidence interval [CI], 0.65–0.95; P < .01) and myocardial infarction (odds ratio, 0.63; 95% CI, 0.39–1.00; P = .05) and had higher adherence to lipid-lowering medication (odds ratio, 1.57; 95% CI, 1.14–2.17; P = .006) compared with controls. They also had increased adherence to antiplatelet therapy compared with controls (odds ratio, 1.42; 95% CI, 1.01–1.98; P = .04). There was no statistically significant difference in the risk of cardiovascular death (odds ratio, 0.68; 95% CI, 0.40–1.15; P = .68), major adverse cardiac events (odds ratio, 0.79; 95% CI, 0.55–1.14; P = .21),or revascularization (odds ratio, 0.87; 95% CI, 0.66–1.16; P = .36) between NLC patients and controls.

CONCLUSIONS:: The available evidence suggests a favorable effect of NLCs on all-cause mortality, rate of major adverse cardiac events, and adherence to medications in patients with CVD.

Original languageEnglish (US)
JournalJournal of Cardiovascular Nursing
DOIs
StateAccepted/In press - Feb 5 2015

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Nurses' Practice Patterns
Meta-Analysis
Cardiovascular Diseases
Odds Ratio
Morbidity
Confidence Intervals
Mortality
Myocardial Infarction
Lipids
Medication Adherence
Bibliography
PubMed
MEDLINE
Research Personnel
Databases

ASJC Scopus subject areas

  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine

Cite this

The Impact of Nurse-Led Clinics on the Mortality and Morbidity of Patients with Cardiovascular Diseases : A Systematic Review and Meta-analysis. / Al-Mallah, Mouaz H.; Farah, Iyad; Al-Madani, Wedad; Bdeir, Bassam; Al Habib, Samia; Bigelow, Maureen L.; Murad, Mohammad H; Ferwana, Mazen.

In: Journal of Cardiovascular Nursing, 05.02.2015.

Research output: Contribution to journalArticle

Al-Mallah, Mouaz H. ; Farah, Iyad ; Al-Madani, Wedad ; Bdeir, Bassam ; Al Habib, Samia ; Bigelow, Maureen L. ; Murad, Mohammad H ; Ferwana, Mazen. / The Impact of Nurse-Led Clinics on the Mortality and Morbidity of Patients with Cardiovascular Diseases : A Systematic Review and Meta-analysis. In: Journal of Cardiovascular Nursing. 2015.
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AU - Farah, Iyad

AU - Al-Madani, Wedad

AU - Bdeir, Bassam

AU - Al Habib, Samia

AU - Bigelow, Maureen L.

AU - Murad, Mohammad H

AU - Ferwana, Mazen

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N2 - BACKGROUND:: Nurse-led clinics (NLCs) have been developed in several health specialties in recent years. The aim of this analysis is to summarize and appraise the available evidence about the effectiveness of NLCs on the morbidity and mortality outcomes in patients with cardiovascular diseases (CVDs).METHODS:: We searched Cochrane databases, MEDLINE, Web of Science, PubMed, EMBASE, Google Scholar, BIOSIS, and bibliography of secondary sources from inception through February 20, 2013. Studies were selected and data were extracted independently by 2 investigators. Eligible studies were randomized trials of NLCs of patients with CVD. Of 56 potentially relevant articles screened initially, 12 trials met the inclusion criteria. The outcomes of interest were all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, major adverse cardiac events, revascularization, lipids control, and adherence to antiplatelet medications. We performed random-effects meta-analysis to estimate summary risk ratios and quantified between-studies heterogeneity with the I statistic.RESULTS:: The 12 trials allocated 4886 patients to NLCs and 4954 patients to usual care. The NLC patients had decreased all-cause mortality (odds ratio, 0.78; 95% confidence interval [CI], 0.65–0.95; P < .01) and myocardial infarction (odds ratio, 0.63; 95% CI, 0.39–1.00; P = .05) and had higher adherence to lipid-lowering medication (odds ratio, 1.57; 95% CI, 1.14–2.17; P = .006) compared with controls. They also had increased adherence to antiplatelet therapy compared with controls (odds ratio, 1.42; 95% CI, 1.01–1.98; P = .04). There was no statistically significant difference in the risk of cardiovascular death (odds ratio, 0.68; 95% CI, 0.40–1.15; P = .68), major adverse cardiac events (odds ratio, 0.79; 95% CI, 0.55–1.14; P = .21),or revascularization (odds ratio, 0.87; 95% CI, 0.66–1.16; P = .36) between NLC patients and controls.CONCLUSIONS:: The available evidence suggests a favorable effect of NLCs on all-cause mortality, rate of major adverse cardiac events, and adherence to medications in patients with CVD.

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