A systematic review on the effectiveness of nurse-led cardiac clinics for adult patients with coronary heart disease.

Aim: Nurse-led clinics offer the possibility of patient education, support and continuity of care for patients with Coronary Heart Disease (CHD) to address and reduce risk factors. The objective of this review is to present the best available evidence related to nurse-led cardiac clinics for adults with CHD by updating an existing systematic review.

Methods: Twenty databases for published literature and 11 databases or websites for unpublished literature were searched for the period September 2002 to March 2008. Additionally, reference lists of retrieved articles were reviewed and relevant journals were hand searched. Assessment for methodological quality, data extraction and synthesis was undertaken using a systematic review management tool (JBI-SUMARI).

Results: Seven RCTs formed the basis for this systematic review, however, in many cases meta-analysis was not possible because of a lack of relevant data. The major nurse-led intervention applied in the clinics consisted of health promotion through educating and counselling the patients. There were no harmful effects on patients with CHD identified when exposed to a nurse-led clinic. Few risk factors were significantly reduced by attending nurse-led clinic, but particular in the long-term no success in risk factor reduction was achieved. Difficulties were obvious in modifying behaviour changes concerning smoking cessation and diet adherence. Nurse-led clinics may positively influence perceived quality of life and general health status, especially physical functioning.

Conclusion: The results indicated that care was equivalent to non-nurse led clinics, and there was no greater risk of poorer outcomes in the nurse-led clinics. The effectiveness of clinics might be dependent on the intensity of the nursing support. The combination of counselling and regular assessment of risk factors and health status delivered at nurse-led clinics is supported by the available research, and given that outcomes were in general equivalent between nurse-led and other clinics, further research should investigate the cost effectiveness of the different models of care.

Implication For Practice: Before establishing a nurse-led clinic appropriate qualification and responsibilities, as well as the particular structure of the health care system and funding possibilities have to be considered.

Implication For Research: Additional research on the effectiveness of selected interventions in nurse-led clinics is necessary. A systematic review on cost-effectiveness should be undertaken.