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Cardiac risk factors and prevention
Original research article
Nurse-coordinated care improves the achievement of LDL cholesterol targets through more intensive medication titration
  1. Marjolein Snaterse1,
  2. Harald T Jorstad2,
  3. Marlies Heiligenberg1,
  4. Gerben ter Riet3,
  5. S Matthijs Boekholdt2,
  6. Wilma Scholte op Reimer1,2 and
  7. Ron J Peters2
  1. 1 ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
  2. 2 Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
  3. 3 Department of General Practice, Academic Medical Center, Amsterdam, Netherlands
  1. Correspondence to Marjolein Snaterse; m.snaterse{at}hva.nl, m.snaterse{at}amc.uva.nl

Abstract

Background 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.

Methods 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.

Results 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).

Conclusion 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.

Trial Registration number TC1290 (Netherlands).

  • acute coronary syndrome
  • lipid-lowering medication
  • LDL-cholesterol target
  • titration
  • secondary prevention

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/openhrt-2017-000607

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    Footnotes

    • Contributors MS, HTJ, GtR, SMB, WJMSR and RJG participated in the design of secondary analysis. HTJ was responsible for the coordination and acquisition of the trial data. MS, HTJ and MH attributed to the draft versions of the manuscript. MS, HTJ, MH and GtR performed the statistical analysis. All authors contributed to the preparation, critical review and approved the final manuscript.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval AMC Amsterdam Medical Ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.