Nurses' observational study on the practice of secondary prevention in a cardiovascular department

Although interventional studies have established the prognostic importance of the control of risk factors in patients with cardiovascular disease, reviews invariably show that the implementation of secondary prevention in patients with cardiovascular disease during hospitalization for acute manifestations or interventions is unsatisfactory. The aim of this study was to observe secondary prevention practice in a cardiovascular department, as part of a quality assurance program.

Two hundred and twenty patients discharged from the intensive coronary care unit, cardiac surgery unit and vascular surgery unit were prospectively included. Data were extracted from medical records and discharge documents. One hundred and eleven patients with at least one modifiable risk factor which was previously not corrected, were interviewed at discharge and were reassessed 3 months later.

Written prescriptions about smoking cessation and weight reduction were given to 7 and 3% of smokers and overweight patients respectively. In 17% of patients no lipid measurement was reported, and in 49% of patients with low-density lipoprotein (LDL) cholesterol levels > 129 mg/dl statins were not prescribed. In patients with a history of infarction, aspirin and beta-blockers were prescribed in 90 and 64% respectively. In diabetics, statins were prescribed to 48% and angiotensin-converting enzyme inhibitors to 31%. Less than 40% of patients were able to refer appropriate levels for their blood pressure, weight, and cholesterol, and 30% fully comprehended the importance of smoking cessation. At the 3-month follow-up visit, 37% of patients had LDL cholesterol levels > 129 mg/dl--in half of these patients despite statins. In 61% of diabetics glycemic control was poor, and one third of smokers had not stopped smoking.

These observations by the nurses have shown pitfalls in the implementation of guidelines, due to incomplete risk assessment, insufficient drug treatment and ineffective patient education. These data are the starting point for upcoming actions of quality improvement in the cardiovascular department of our hospital.