11-years of a nurse-led follow-up service for patients who have undergone percutaneous coronary intervention
S Harrison, J Bellchambers, R Byrne, S Deane, N Dent, N Mackay, A Pottle- Advanced and Specialized Nursing
- Medical–Surgical Nursing
- Cardiology and Cardiovascular Medicine
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The nurse-led follow-up service for patients who have undergone percutaneous coronary intervention (PCI) was established in 2001 to standardise post procedural care for this patient group. The appointment focusses on symptom assessment, medication review and optimisation, and risk factor modification and secondary prevention. Timing of appointments is dependent on the procedure the patient has undergone (primary/elective PCI) and the format of the service has changed several times since its inception in response to changes in the PCI service within the hospital. Clinic appointments were carried out face to face or via the telephone until 2020, when all clinics changed to virtual appointments (video or telephone).
Methods
Data for all patients reviewed in the clinic was collected prospectively and retrospectively analysed. This report covers the period 2010-2021.
Results
A total of 21,465 appointments were carried out in the above audit period. Most appointments were carried out in the first-year post PCI in accordance with the follow-up protocol (81.7%). Patients reviewed after 1-year were usually referred to the clinic by their GP due to recurrence of symptoms. 71.3% of patients reviewed within the first year were free of any symptoms of angina or had no limitation to physical activity, and 71.2% were not limited by breathlessness at any follow-up appointment. 33.6% patients reviewed within the first year were either attending or had attended a cardiac rehabilitation programme, with fewer patients declining referral in more recent years. 19.3% patients reviewed within the first year were diabetic, with 5.4% diagnosed on admission. 8.5% patients were still smoking, 41.0% had stopped smoking, and less than 1.0% patients had restarted smoking within the first year. 49.2% patients reviewed within the first year had a systolic blood pressure below 140mmHg, and 56.0% patients had a diastolic blood pressure below 90mmHg, however this data was not available for all patients. The data suggests that lipid management has improved within recent years with more patients achieving LDL levels below 2.0mmol/L, however, this data is also incomplete. Over 92.0% patients were taking Aspirin at 1-month and 1-year, with 95.0% patients taking a second antiplatelet agent at 1 month, and 76.6% at 1-year. Beta blocker, ACE inhibitor and statin use has been relatively consistent at 71.6%, 66.1% and 82.5% respectively at all appointment times.
Conclusion
This nurse-led follow-up service provides consistency of care for patients who have undergone PCI. The nurses in the clinic are able to optimise risk factors and medication, although further work needs to be done to achieve guideline directed targets. Collaboration with primary care is required to ensure secondary prevention is continued.