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Do nurse interventions cut cardiovascular disease in people with severe mental illness?

Study of more than 70 primary care practices in England finds increased risk factors

Study of more than 70 primary care practices in England finds increased risk factors


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Research into how best to prevent heart attacks or strokes in people with severe mental illnesses (SMI) across 76 primary care practices in England found that practice nurses adhered to the intervention and behaviour change components more than healthcare assistants (HCAs).

People with SMI die up to 20 years earlier than the general population from cardiovascular disease (CVD). They have increased risk factors, but are less likely to be screened or receive interventions to reduce their risk. A risk model for predicting CVD events was developed, and a cohort study demonstrated the extent statins prevented CVD events in people with SMI.

An intervention then offered 137 patients with SMI and two or more CVD risk factors 8-12 appointments with a nurse or HCA over six months, while 152 patients in the control practices received usual care. The nurses and HCAs were trained in collaborative behaviour change techniques to address CVD risk factors (adhering to statins, smoking, exercise),

Intervention group

Cholesterol levels were reduced in both groups at 12 months and there were no significant differences on any other measures (metabolic, well-being and medication adherence). Health costs were significantly lower for the intervention group, mainly through less inpatient costs. A sample of audio-recorded appointments of the intervention identified about 67% of the intervention components were delivered.

None of the nurses or HCAs addressed statin adherence or initiation. Nurses were significantly more faithful in their adherence to the intervention and behaviour change components than the HCA. Further research is required.


Reference

Osborn D, Burton A, Walters K et al (2019) Primary care management of cardiovascular risk for people with severe mental illnesses: the Primrose research programme including cluster RCT. NIHR Programme Grants for Applied Research. 7,2


Vari Drennan is professor of healthcare and policy research at Kingston University and St George’s, University of London

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