Nurse-led clinics as an effective service for cardiac patients: results from a systematic review

The article summarises results of a systematic review on the effectiveness of nurse-led clinics for patients with coronary heart disease. The objective was to present the best available evidence related to effective interventions in nurse-led cardiac clinics including patient education, risk factor assessment and continuity of care.

Following the principles of the Cochrane Collaboration for systematic reviews on effectiveness, this is an update to a previously published review. Thirty databases, relevant journals and hand searching of reference lists were the basis for a comprehensive literature search for the period September 2002 to March 2008. Assessment of methodological quality, data extraction and synthesis was undertaken using a systematic review management tool (JBI-SUMARI). When possible, data was pooled in a meta-analysis.

The systematic review is based on seven randomised controlled trials. Inconsistencies of interventions executed in nurse-led clinics and various effects on the outcomes make a comparison difficult. The major nurse-led intervention applied in the clinics consisted of health education, counselling behaviour change and promotion of a healthy lifestyle. There were no harmful effects on patients with coronary heart disease identified when exposed to a nurse-led clinic. A few risk factors were significantly reduced in the short term by attending nurse-led clinics, but long-term changes were less apparent. The success of modifying behaviour such as smoking cessation and diet adherence was limited. However, nurse-led clinics may positively influence perceived quality of life and general health status.

The results indicated that care was equivalent to non-nurse-managed 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. Before establishing a nurse-led clinic appropriate qualification and responsibilities, as well as the particular structure of the healthcare system and funding possibilities have to be considered. 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.