Nurse led shared care for patients on the waiting list for coronary arterybypass surgery: a randomised controlled trial

Objective-To evaluate the effectiveness of a nurse led shared care programm e to improve coronary heart disease risk factor levels and general health s tatus and to reduce anxiety and depression in patients awaiting coronary ar tery bypass grafting (CABG). Design-Randomised controlled trial. Setting Community, January 1997 to March 1998. Study groups-98 (75 male) consecutive patients were recruited to the study within one month of joining the waiting list for elective CABG at Glasgow R oyal Infirmary University NHS Trust. Patients were randomly assigned to usu al care (control; n = 49) or a nurse led intervention programme (n = 49). Intervention-A shared care programme consisting of health education and mot ivational interviews, according to individual need, was carried out monthly . Care was provided in the patients' own homes by the community based cardi ac liaison nurse alternating with the general practice nurse at the practic e clinic. Outcome measures-Smoking status, obesity, physical activity, anxiety and de pression, general health status, and proportion of patients exceeding targe t values for blood pressure, plasma cholesterol, and alcohol intake. Results-Compared with patients who received usual care, those participating in the nurse led programme were more likely to stop smoking (25% upsilon 2 %, p = 0.001) and to reduce obesity (body mass index > 30 kg/m(2)) (16.3% u psilon 8.1%, p = 0.01). Target systolic blood pressure improved by 19.8% co mpared with a 10.7% decrease in the control group (p = 0.001) and target di astolic blood pressure improved by 21.5% compared with 10.2% in the control group (p = 0.000). However, there was no significant difference between gr oups in the proportion of patients with cholesterol concentrations exceedin g target values. There was a significant improvement in general health stat us scores across all eight domains of the 36 item short form health survey with changes in difference in mean scores between the groups ranging from 8 .1 (p = 0.005) to 36.1 (p < 0.000). Levels of anxiety and depression improv ed (p < 0.000) and there was improvement in time spent being physically act ive (p < 0.000). Conclusions-This nurse led shared care intervention was shown to be effecti ve for improving care for patients on the waiting list for CABG.