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Paper of the Day - Nurse-led clinics improve CV outcomes

Disease management clinics for coronary heart disease lead to better BP control and more appropriate prescribing, while patients with unconfirmed heart failure are almost five times more likely to get a definitive diagnosis, say UK primary care researchers.

Their trial of 1316 patients with CHD and coronary heart failure, was the first to look at outcomes from primary care clinics for heart failure. It compared an intensive nurse-led programme with usual care in 20 primary care practices in Leicester.

The intensively-managed programme included confirmation of diagnosis, medication management, home visits and referral to a secondary care cardiology clinic. At the end of the study, patients with CHD in the intervention group were 43% more likely to get a beta-blocker, 61% more likely to get their BP down to target and 58% more likely to get total cholesterol below 5 mmol/l.

More patients in the intensively managed group received smoking cessation interventions and were referred for echocardiography to clarify left ventricular systolic dysfunction in patients with presumed heart failure, compared with the usual care group. The odds ratio of having a diagnosis of LVSD in the intervention group was 4.69.

The authors of the study said that their results showed that disease management programmes could be implemented easily in primary care and could help GPs meet QOF targets.

Heart 2007; 93: 1398-1405

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