January 30, 2012

Nursing research article is editor’s pick in AHA journal

An article by Johns Hopkins University School of Nursing researchers was selected as an editor’s pick in a recent issue of the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes. The study, “Community Outreach and Cardiovascular Health (COACH) Trial: A Randomized, Controlled Trial of Nurse Practitioner/Community Health Worker Cardiovascular Disease Risk Reduction in Urban Community Health Centers,” proves that direct intervention by nurses with patients who have cardiovascular disease has a positive effect on improving cardiovascular care in underserved populations.

Each year, approximately 831,000 Americans die of cardiovascular disease. Despite well-publicized guidelines on the appropriate management of cardiovascular disease and type 2 diabetes, the implementation of risk-reducing practices remains poor. The COACH trial, funded by the National Institutes of Health, was led by Jerilyn Allen, the school’s associate dean for research and the M. Adelaide Nutting Professor in the Department of Acute and Chronic Care, and included fellow Johns Hopkins researchers Cheryl Dennison Himmelfarb, Sarah Szanton, Martha N. Hill and Mary Donnelly-Strozzo.

The trial randomly assigned 525 patients with documented cardiovascular disease, type 2 diabetes, high cholesterol and hypertension into two groups; 261 were assigned to a nurse practitioner/community health worker and 264 to an enhanced usual care group. Participants for the trial were selected between July 2006 and July 2009 from two community health centers in Baltimore.

Those who were assigned to the nurse practitioner/community health worker group focused on lifestyle changes based on behavioral interventions. These included adherence to medications and appointments with their health care providers.

The team also integrated lifestyle modifications, including reminders, logs, pill organizers, alarm clocks or any other method that would assist the patient in following the complex regimens. A low-literacy wellness guide also was developed for the study as a behavioral tool and included a log for lab results, therapeutic goals for weight, blood pressure, lipids and glycated hemoglobin (for diabetic patients) and customized tips for taking medication, as well as for healthy eating, increased physical activity and smoking cessation.

After 12 months, participants who received care from the nurse-led team had significantly greater reductions in total cholesterol (20 mg/dL), bad LDL cholesterol (16 mg/dL) and triglycerides (16 mg/dL). Patients in the nurse-led group also experienced an average systolic blood pressure decrease of 6 mm Hg, a diastolic blood pressure reduction of 3 mm Hg, and a half percent decrease in HbA1c, a test that measures sugar in the blood.

Researchers also found that the patients in the group that saw nurse practitioners had an improved perception of the quality of their chronic illness care, leading them to conclude that the individualized regimens can be effective for high-risk patients.

“Our results prove the value of nurse intervention when it comes to an individual’s health, and add to the collective research that has already been done in cardiovascular care,” Allen said. “Although more research needs to be conducted, this is a major step toward replicating similar community intervention in other urban areas, which in turn will help improve cardiovascular health across the country.”