An advanced nurse-led clinic for patients following percutaneous coronary intervention

Abstract

Percutaneous coronary intervention (PCI) is internationally recognised as the preferred initial treatment for acute coronary syndrome and as a treatment option for chronic coronary heart disease. The use of PCI has led to shorter inpatient stays. However, reduced length of stay can mean less opportunity for patient education. Once discharged from hospital, timely outpatient review encompassing symptom reassessment, advanced physical assessment, medication and cardiovascular risk management is a key component of patient care. In an Irish acute hospital setting, cardiology clinical nurse specialists and advanced nurse practitioners have established an advanced nurse-led post-PCI clinic. This article describes the post-PCI clinic and provides an overview of the patient profile and outcomes over a 2-year period, with an emphasis on advanced nursing roles and patient symptoms.

Framework for roles and responsibilities of nurses in nurse-led cardiovascular disease clinics in primary health care: An integrative review

“…Patient assessment involved taking a health history and conducting a physical assessment. For example, a cardiovascular physical assessment was done at nurse-led CVD clinics [14][15][16][17][18] that involved the assessment of vital signs, such as heart rate, respiratory rate, blood pressure as well as cardiac and peripheral vascular examination, [19][20][21][22] and current health status for patients undergoing open heart surgeries. [14] Furthermore, nurses in nurse-led CVD clinics obtained a history of symptoms before and after percutaneous coronary intervention [20] and assessed symptoms and complications of atrial fibrillation (AF).…”

“…For example, a cardiovascular physical assessment was done at nurse-led CVD clinics [14][15][16][17][18] that involved the assessment of vital signs, such as heart rate, respiratory rate, blood pressure as well as cardiac and peripheral vascular examination, [19][20][21][22] and current health status for patients undergoing open heart surgeries. [14] Furthermore, nurses in nurse-led CVD clinics obtained a history of symptoms before and after percutaneous coronary intervention [20] and assessed symptoms and complications of atrial fibrillation (AF). [23] Moreover, nurses in nurse-led CVD clinics were involved in the assessment of 12-lead electrocardiogram and waist circumference measurement as well as calculating body mass index.…”

“…Patients may need some medication added, stopped, and/or modified. [15-17, 26, 27] According to Ingram et al, [20] 228 patients (48%) who attended the nurse-led clinics in their study needed medication adjustments. More than 96% of patients in Ibrahim et al's [27] study who were receiving statin therapy had their dose adjusted according to their cholesterol levels.…”

“…Referrals for further investigations or other specialty services Nurses in nurse-led CVD clinics have the authority to refer patients to do more lab tests or other special investigations. [16] For example, patients may be referred for exercise stress tests; [15,20] blood tests and Holter monitoring; [20] and CT coronary angiogram. [15] Patients (5.7%) in Ibrahim et al's [27] study were referred to endocrinology because they had recently been diagnosed with diabetes at the nurse-led clinic based on their HbA1C levels.…”

“…For example, patients have improved body weight and systolic blood pressure. [21,22,28] Ingram et al [20] reported that 75% of patients treated at nurse-led clinics were symptom-free, 18% experienced ongoing symptoms, and 7% reported new symptoms. In addition, patients with hypertension who attended nurse-led primary care clinics in a southern Brazilian city in da Silva et al's [21] study had a greater reduction in waist circumference and BMI.…”