Implementation of the cardiovascular assessment screening program (CASP) by nurse practitioners-it's time to focus on early identification of cardiovascular risk
Authors: Bruneau J , Moralejo D , Parsons K , Donovan C 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Newfoundland and Labrador Support for Patient-Oriented Research (NL SUPPORT)

Background
There is inconsistent utilization of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by advanced practice nurses/nurses practitioners (NPs) to identify CVD risk factors early and to intervene using current recommendations. To address this clinical practice issue and increase utilization of Canadian CPGs, an exploratory multiphase sequential mixed methods study was conducted and the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated.

Objective
Phase 2 of the mixed methods study, a cluster randomized controlled trial (cRCT), evaluated the implementation of CASP by NPs with individuals aged 40-74 years, without established CVD or vascular disease (VD), in order to identify CVD risk factors early, to determine the level of risk for a CV event, to calculate the Heart Age, and to set heart health priorities and management, according to current CPGs in Canada.

Methods
In a cRCT, block randomization randomly divided ten NPs into the intervention group clusters (IGCs) and the control group clusters (CGCs). In turn, eight NPs recruited 166 patients in their own communities; the four NP IGCs recruited patients (n=67) and the four NP CGCs recruited patients (n=99). The web-based CASP intervention was implemented with patients in the IGCs, and the CGCs received standard care. The CASP intervention consisted of four components: an electronic CVD Database, an NP toolkit, an educational resource for NPs and patients, and a website containing CPGs. The data on CVD risk factors, Framingham Risk Score (FRS), Heart Age, and priorities for heart health were recorded in the CVD Database utilized by the NP IGCs.

Results
Utilizing the CVD database, CVD risk factors were consistently identified in patients by NPs in the IGCs compared to the NP CGCs. The patients in the IGCs had a high number of risk factors for CVD documented by NPs, including family history of CVD, hypertension, diabetes, obesity, renal dysfunction, and dyslipidemia, and found that 62 patients (91%) were at moderate to high risk for having a CV event in the next 10 years using the FRS. In comparison, NPs in the CGCs did minimal documentation of risk factors; the level of CVD risk was largely unknown (96%) for control group patients as the FRS was only documented on 7 patients (4%). The Heart Age was calculated in the IGCs (92%); in the CGCs, the Heart Age was not calculated. The recommendations made by IGC NPs matched their patients’ priorities 94% of the time; 75% of the intervention group patients developed personalised goals that matched their top priorities for improving heart health.

Conclusion
The key benefit of the CASP implementation by NPs was the identification of CVD risk factors earlier in individuals without established CVD or VD. Engaging individuals to participate in screening to learn about their CVD risk encourages priority setting for heart health using a patient-focused approach.