EULAR recommends cardiovascular (CV) risk assessment for patients with rheumatoid arthritis (RA). My last post discussed the issues associated with monitoring CV risk in the patient with RA.This post will examine how nurses assess and manage patients for CV risk.
Jette Primdahl presented her findings on a review of the literature of 33 articles. She looked at the role of nurses in monitoring CV risk in hospitals, communities and general practice. She found that nurses routinely measure BP, BMI, waist circumference, glucose levels, and lipids. They also look at lifestyle factors including diet, smoking, alcohol consumption and physical activity levels, and non-modifiable CV risk factors such as family history, age, and gender. They also assess adherence to medications and engage in discussions around motivation for change.
The nurses' management strategies varied from giving brief advice to comprehensive follow-up. Some nurses used a holistic approach to care and an individualized, tailored approach to treatment, while other nurses used broader approaches.
Nurses used motivational interviewing and goal setting techniques as strategies for management. They also offered additional information such as brochures and educational materials. They referred patients to other health care professionals such as physiotherapy. In some cases they were able to initiate or titrate medications in areas where an extended class role exists.
This review found that CV risk assessment and management by nurses is quite appropriate in the general patient population. Assessment and management of CV risk are relevant tasks for rheumatology nurses.
Rheumatology nurses should have adequate training in CV risk assessment and risk scoring on composite scales in order to monitor patients effectively. Training in motivational interviewing, goal setting, shared decision-making and other management strategies may be helpful. The EULAR guidelines recommend monitoring a minimum of every 5 years, however, closer follow-up is necessary to actually change behaviour.