Does nurse case management improve implementation of guidelines for cardiovascular disease risk reduction?

Over the last 5 decades, research has demonstrated that cardiovascular risk reduction mediated through medical and surgical therapies, as well as lifestyle change, reduces morbidity and mortality from diseases of the vascular system. Based on this extensive research, government and professional organizations publish evidence-based guidelines for the management of patients with, or at risk of developing, cardiovascular disease. However, recommended interventions are frequently neither initiated nor adhered to, and when appropriate therapies are initiated, patient adherence is poor. This review sought to evaluate how nurse-based case management (NCM) according to recommended guidelines improves patient outcomes and enhances cardiovascular risk reduction.

English-language articles (1950 to January 2009) were identified using a combination of the following terms: (case) management; nurse(-led) or nursing; guideline and/or implement or implementation; cardiovascular (disease) (risk); hypertension or dyslipidemia, or diabetes, or smoking (cessation), or nutritionist, or cardiac rehabilitation. Primary articles were reviewed for focus on modifiable risk factor management involving a nurse acting as a "case manager," having a prominent role within the management of a patient's cardiovascular health, and following scientifically based, published guidelines.

From the Stanford Coronary Risk Intervention Project in the 1990 s to EUROACTION published 2008, NCM has appreciably evolved. The studies summarized demonstrate that individualized, systematic, and guideline-based NCM can translate into clinically meaningful reductions in cardiovascular-related morbidity and mortality. Furthermore, the NCM model was effective for hospitalized patients, especially during the postdischarge period, in primary care, low-income clinics, and in the community including the workplace. Providing NCM for those at risk of or with cardiovascular disease may help toward reducing the related loss of productive lives and the enormous costs to society.