Management of coronary risk factors by registered nurses versus usual carein patients with unstable angina pectoris (A Chest Pain Evaluation in The Emergency room [CHEER] substudy)

This study examined whether nurses could manage coronary risk factors in pa tients with unstable angina more effectively than physicians practicing usu al care. Three hundred twenty-six patients were randomized in the emergency room to a 6-month program of risk factor management by a registered nurse versus participation in usual care. The nurse intervention consisted of a 3 0-minute counseling visit at 6 to 10 days after the chest pain episode and a second 30-minute session 1 month later. Multiple risk factors were assess ed and addressed: smoking, blood lipids, blood pressure, blood glucose, phy sical inactivity, weight, psychological stress, and social isolation. Compa red with usual care, nurse intervention patients significantly reduced both triglycerides (-29 +/- 8 vs 5 +/- 6 mg/dl; p <0.0004) and weight (-0.9 +/- 3.3 vs +0.1 +/- 2.1 kg; p = 0.0071), and had corresponding improvements in self-reported diet compliance and exercise (+34 +/- 106 vs +9 +/- 98 minut es, p = 0.0491). No significant differences between groups were observed in terms of 6-month changes in total, high-density lipoprotein, or low-densit y lipoprotein cholesterol, blood pressure, fasting blood glucose, percent b ody fat or waist-hip ratio, or psychological distress scores. The 6-month r ate of recurrent events (cardiac death, out-of-hospital cardiac arrest, myo cardial infarction) and/or revascularizations (coronary artery bypass surge ry or coronary angioplasty) was lower in the nurse intervention group (1% v s 9%; p = 0.002). We conclude that a nurse-delivered risk factor interventi on program for patients with chest pain is feasible and more effective than usual care in terms of fostering lifestyle changes that may lower coronary risk. (C)2000 by Excerpta Medico, inc.