Snaterse Marjolein, Jorstad Harald T, Heiligenberg Marlies, Ter Riet Gerben, Boekholdt S Matthijs, Scholte Op Reimer Wilma, Peters Ron J
ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Open Heart. 2017 Jul 11;4(2):e000607. doi: 10.1136/openhrt-2017-000607. eCollection 2017.
Nurse-coordinated care (NCC) improves the achievement of low-density lipoprotein-cholesterol (LDL-C) targets after an acute coronary syndrome (ACS). We hypothesised that NCC improves achievement of LDL-C targets through more intensive medication titration.
We used data from Randomised Evaluation of Secondary Prevention by Outpatient Nurse Specialists (RESPONSE), a multicentre randomised trial on the efficacy of NCC in 754 ACS patients. Follow-up data were collected at 6 and 12 months. To enable comparison between the various types and dosages of statins, we used the average lipid-lowering potency (ALLP, % LDL-C lowering) as an indicator of lipid-lowering medication intensity.
Most patients in NCC intervention and usual care groups (96%) had started lipid-lowering therapy during the index hospitalisation. At 6 months, titration activities (up or down) were applied in 45% of NCC patients compared with 24% of patients receiving usual care (p<0.001), and a difference was also seen at 12 months follow-up (52% vs 34%, p<0.001). In patients not on LDL-C target at baseline, titration activities at 6 months were recorded in 63% and 30% of NCC and usual care patients respectively (p<0.001), with increased titration activities in both groups at 12 months (69% vs 43%, p<0.001).
NCC is associated with more frequent and intense lipid-lowering medication titration to reach LDL-C targets as compared with usual care alone. Further, merely starting the guideline-recommended dose is insufficient to reach the guideline-recommended LDL-C target level.
TC1290 (Netherlands).
护士协调护理（NCC）可提高急性冠状动脉综合征（ACS）后低密度脂蛋白胆固醇（LDL-C）目标的达成率。我们假设NCC通过更强化的药物滴定来提高LDL-C目标的达成率。
我们使用了门诊护士专家二级预防随机评估（RESPONSE）的数据，这是一项关于NCC对754例ACS患者疗效的多中心随机试验。在6个月和12个月时收集随访数据。为了能够比较不同类型和剂量的他汀类药物，我们使用平均降脂效力（ALLP，LDL-C降低百分比）作为降脂药物强度的指标。
NCC干预组和常规护理组的大多数患者（96%）在首次住院期间开始了降脂治疗。在6个月时，45%的NCC患者进行了滴定活动（上调或下调），而接受常规护理的患者为24%（p<0.001），在12个月随访时也存在差异（52%对34%，p<0.001）。在基线时未达到LDL-C目标的患者中，6个月时NCC组和常规护理组分别有63%和30%的患者进行了滴定活动（p<0.001），两组在12个月时滴定活动均增加（69%对43%，p<0.001）。
与单纯常规护理相比，NCC与更频繁、更强化的降脂药物滴定以达到LDL-C目标相关。此外，仅开始使用指南推荐的剂量不足以达到指南推荐的LDL-C目标水平。
TC1290（荷兰）。
