Nurse-led care for ACS successful

Nurse-led acute coronary syndromes (ACS) management can provide evidence based care and significantly reduce hospital readmissions, says a new study. Published in the British Journal of Cardiology, the study examined the effects of a UK nurse-led patient assessment and ACS clinic over a 12 month period. In-patients were seen by a cardiac outreach nursing team and depending on their TIMI risk profile they were managed by either cardiologists in a designated acute cardiac unit (ACU) or a nurse-led ACS clinic. Nearly 160 patients were referred to the ACU with unstable angina or non-ST elevation myocardial infarction, of whom nearly half were given coronary angiography, 15% were treated with PCI and 4% were treated with CABG. Less than 30% of the patients were readmitted after six months, with about half readmitted within one month of discharge. The rate of re-admission in in-patients who had coronary angiography was almost half that of those who did not (20% vs 36.6%). Over 300 patients were seen in the nurse-led ACS clinic, which was audited both before and at the end of a 12 month period. Less than 14% of the ACS clinic patients were readmitted within six months, which the study’s authors said was a significant reduction on the first audit (p=0.0002). Around 45% of the patients from the clinic were managed by cardiologists from the ACU, with less than 20% of those patients going on to be re-admitted to hospital within six months. Furthermore, 85% of the patients who attended the nurse-led clinic had their medications titrated or altered and their uptake of rehabilitation was over 90% (compared with 60% in the first audit). Most patients reported feeling happy with seeing a nurse within two weeks, rather than within four months if waiting to see a doctor. “A nurse-led ACS clinic can provide evidence-based care and significantly reduce readmissions. This is the result of the information, reassurance and support that are provided in the vital early stages, as well as the early surveillance for recurrence of symptoms. The high discharge rate [also] frees up space in hard-presses cardiology clinics,” the study’s authors said. Br J Cardiol 2009;16:132-4....