A nurse-based pilot program to reduce cardiovascular risk factors in a primary care setting

To evaluate the effectiveness of a nurse-based cardiovascular disease (CVD) risk factor reduction program among patients at a primary care outpatient clinic.

Preintervention and postintervention longitudinal, prospective pilot study to evaluate patients' achievement of CVD risk factor reduction.

A total of 436 patients at a primary care clinic in suburban Minneapolis, Minnesota, were enrolled in 2 years; 286 patients were followed up with additional visits. The nurse intervention included comprehensive CVD risk assessment, patient education, and counseling. Algorithms guided the development of individualized care plans based on laboratory test values, blood pressure readings, tobacco use, and history of cardiovascular events. Physicians were consulted for serious changes in patients' medical conditions or for medication changes. Three measures were compared from baseline to the end of the program: blood pressure, low-density lipoprotein cholesterol levels, and tobacco use.

Statistically significant reductions were achieved from baseline to the final nurse visit in systolic blood pressure (from 155.8 to 143.4 mm Hg), diastolic blood pressure (from 94.4 to 84.0 mm Hg), and dyslipidemia (low-density lipoprotein cholesterol, from 4.15 to 3.80 mmol/L [from 160 to 147 mg/dL]) (P < .001 for all). Of the 40 tobacco users who participated in the program, 12 discontinued use (30%).

This pilot study provides preliminary evidence of the effectiveness of a nurse-based CVD risk reduction program. Further study is needed to target high-risk patients and to compare results in the nurse intervention group with those in patients receiving usual care.