Nurse case management of hypercholesterolemia in patients with coronary heart disease: Results of a randomized clinical trial

Abstract

Background Despite the large body of evidence confirming the effectiveness of lipid lowering for the secondary prevention of coronary heart disease (CHD) events, undertreatment of hyperlipidemia is common. This study tested the effectiveness of a nurse case management program to lower blood lipids in patients with CHD. Methods A total of 228 consecutive, eligible adults with hypercholesterolemia and CHD were recruited during hospitalization after coronary revascularization. Patients were randomized to receive lipid management, including individualized lifestyle modification and pharmacologic intervention, from a nurse practitioner for 1 year after discharge in addition to their usual care (NURS), or to usual care enhanced with feedback on lipids to their primary provider and/or cardiologist (EUC). Results Significantly more patients in the NURS group than in the EUC group achieved low-density lipoprotein cholesterol (LDL-C) levels <2.59 mmol/dL (100 mg/dL, 65% vs 35%, P =.0001). Favorable changes in lipids and lipoproteins were accompanied by significant improvements in dietary and exercise patterns in the NURS group. In a multivariate analysis adjusting for other covariates, being assigned to the NURS group (P =.0001) and being on a lipid-lowering medication (P =.001) were significant independent predictors of LDL-C level. Conclusions Control of hypercholesterolemia in patients who have undergone coronary revascularization can be improved by a nurse case-management program. Because the National Cholesterol Education Program Adult Treatment Panel III guidelines have broadened the definition of high-risk populations that warrant aggressive treatment, nurse case-management programs may offer key opportunities to enhance appropriate application of new treatment paradigms. (Am Heart J 2002;144:678-86.)