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One of the best tools to help practitioners make the best bedside clinical decisions when managing patients with acute cardiovascular disease.
A comprehensive guidelines implementation toolkit especially for Nurses & Allied Professionals.
Prof. Massimo F. Piepoli
Dr. Ugo Corra
Dr. Jeroen Hendriks
Preventive measures in risk factor control, recommended for patients with ischaemic heart disease, are reviewed, according to the recent 6th Joint Task Force European Guidelines. They require multidisciplinary intervention to succeed in lifestyle changes, as well pharmacological optimization.
Ischaemic heart disease (IHD) is associated with multiple cardiovascular conditions or risk factors and consequently, treatment can be complex. Therefore, treatment deserves a comprehensive management approach, including pharmacotherapeutic and invasive or surgical therapies, professional lifestyle interventions based on behavioural models of change, with different strategies from more basic, family-based to more structured and complex modalities, depending on the cardiovascular risk assessment and on concomitant diseases (1). Risk factor management focusing on controlling related cardiovascular risk factors, including physical activity advice, psychosocial support and appropriate prescription of and adherence to cardio-protective drugs are integral to helping patients regain as full a life as possible and improve their quality of life.
Prevention should be started immediately after an ischaemic event; it should start during the acute phase and continued in the post-acute phase, and in fact: should continue for the rest of the patient’s life.
Beyond initial assessment, several preventive measures are recommended for IHD patients (Table 1). To favour continuity of care and prevention, a discharge schedule should be set up, according to the individual needs and preferences of the patient, to select and to arrange the next care setting and health care services, to promote patient and family preventive and education issues, to organize the follow-up, and to ensure medication reconciliation. A discharge report that includes patient’s functional status, medical history, baseline information, learning needs, care plans, and services provided should be given out.
Unfortunately, large proportions of IHD patients still do not achieve the lifestyle, risk factor and therapeutic targets (EUROASPIRE IV database). A confirmation of this, is the insufficient implementation of evidence-based guidelines on prevention. Multidisciplinary teams or nurse-coordinated risk factor management may be of help in optimizing this.
This table is derived from 2016 ESC guidelines on Cardiovascular Disease Prevention in Clinical Practice.
 Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney M-T, Corra` U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen M-L, Lollgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van derWorp HB, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; doi:10.1093/eurheartj/ehw106.
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