LOGIC March 2018 Vol 17 Vol 1 - Page 25

compared to the RC group (2.66 vs 3.00 mmol/L, p = 0.024), but unexpectedly, not for the secondary prevention patients. This was thought to be due to secondary prevention patients starting with a lower LDL-C baseline rate due to a short washout period of 2 weeks of their statin therapy prior to the study. The interventions used by Nieuwkerk et al (2012) included four nurse contacts with patients in their study (n=201), at baseline and at 3, 9 and 18 months. Patients were provided with an individualized risk-factor passport that showed their 10-year CVD risk, their individual modifiable and non-modifiable CVD risk factors and a target CVD risk they could achieve if they modified all of their modifiable risk factors. At each visit patients completed a self-administered questionnaire to assess statin adherence, symptoms, anxiety, smoking status and quality of life (QoL) and had their lipid levels assessed. Irewall et al (2015) used nurse- led, telephone-based interventions for secondary prevention after stroke and transient ischaemic attack. Lifestyle counselling and assessment of pharmacological treatment resulted in improved March 2018 L.O.G.I.C LDL-C and blood pressure (BP). BP and lipids were tested at baseline and at 12 months. If the baseline BP and LDL-C were above target, the nurse initiated a physician assessment and adjustment of the medication. Each physician adjustme nt of medication was followed up in 4 weeks to see if BP and LDL-C met target levels. The process was repeated 4 weekly until the targets were met. A key factor in achieving success in this study was believed to be timely adjustment of medication and monitoring of patient risk factors. Irewall et al (2015) thought that interventions would need to continue for longer than 12 months to maintain control over risk factors. Nurse Strategies to Increase Statin Adherence a. Patient education on CVD risk and management strategies • Ensure patients understand their CVD risk and modifiable and non-modifiable risk factors, and associated management strategies. This can be helped by using interactive patient risk calculators and tools such as “Know Your Numbers” (Heart Foundation 2012) or the “Your Heart Forecast” • • tool (Heart Foundation 2017). Develop a therapeutic alliance by using a patient-centred approach to define the patient’s goals, priorities and preferences and by keeping these foremost in development of management strategies and health plans. This approach is more likely to empower the patient and increase adherence with treatment as well as increase patient well- being and satisfaction with their care (Harbman 2014). In primary care, nurse- led CVD risk assessments can be an opportunity for providing patient education or an opportunity could be taken during a nurse appointment for another reason (if appropriate). Primary care nurse-led clinics, nurse-led patient appointments or telephone follow-ups specifically for high risk patients for primary or secondary prevention of CVD can be used but there is a time and cost factor associated with this to be balanced against other general 23