Nurse Case Managers Help Diabetics Lower Heart Disease Risk

Nurse case managers can help patients with diabetes control cardiovascular risk factors, lowering their chance of adverse cardiovascular effects, according to a study conducted at the Minneapolis VA Healthcare System (MVAHCS). ¹

Patients in the intervention group were assigned nurse case managers who collaborated with them on lifestyle modification goals. These included weight loss, dietary changes, physical activity and smoking cessation. The case manager reviewed diabetes, blood pressure and lipid medications and made adjustments to those medications according to protocols established for the study.

Case managers contacted patients every two weeks during the initial portion of the 12-month study, decreasing contact as the patients achieved blood pressure and glucose goals. During telephone contacts, case managers reviewed self-monitoring values for blood glucose and blood pressure, any difficulties the patients were having measuring those factors, their progress toward lifestyle modification goals, and any adverse events they were experiencing as part of the therapy. If necessary, the case manager made adjustments to the patients’ mediations.

Using the electronic medical record system, the  primary-care provider was informed of all medication changes. Providers outside the VA system were sent letters informing them of the changes.

Of the 556 individuals in the study, half received the intervention therapy. They represented a typical VA patient — older, male and Caucasian.

By the end of the study, a greater number of intervention patients had their blood pressure, lipid level and glucose level under control. However, which particular aspect of the case management was the most effective is unknown — whether it was adherence to medication, changes in diet or the course corrections in the treatment regiment over time.

There was no difference in the rate of hospitalization or death between the intervention and the control group.

1. Ishani A, Greer N, Taylor BC, Kubes L, Cole P, Atwood M, Clothier B, Ercan-Fang N. Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial. Diabetes Care. 2011 Aug;34(8):1689-94. Epub 2011 Jun 2. PubMed PMID: 21636796; PubMed Central PMCID: PMC3142048.

Ethnic Minorities May Be Less Likely To Receive CV Surgery

Some race-related disparities of care for cardiovascular disease may persist for veterans receiving treatment in the VA healthcare system, according to research conducted by the Central Texas Veterans Health Care System. ¹

The study looked at both the effect of depression on surgical care and the differences in the receipt of surgical interventions for ethnic minority patients. Researchers looked at data for patients treated between 2005 and 2009.

Among the 317,072 patients sampled, 18,334 had surgery (6%). Patients in the study sample averaged 63 years of age (SD 15, range 18–103) and included 5% women veterans, 5% Hispanic and 17% African-American patients. Coronary artery bypass graft (CABG) and vascular operations were the most common.

According to the study, depression showed a pervasive dampening effect on the likelihood of having digestive, hip/knee, vascular and CABG surgeries. Also, Hispanic ethnicity and African-American race were somewhat associated with decreased likelihood to receive surgery in the VHA relative to white patients.

Coronary artery bypass graft and vascular operations were less common among minority veterans, even after controlling for mortality-associated comorbidity including several cardiovascular diagnoses, chronic conditions, age, gender, priority and depression status.

Part of this could be explained by the relatively younger age of Hispanic and African-American veterans. Hypertension, however, was as prevalent among African-American as white veterans (57%).

The study also found that presurgical major depressive disorder was uniformly associated with a reduced likelihood of surgery — an effect that was independent of ethnicity.

1. Copeland LA, Weber JE, Pugh MJ, Phillips KL, Lawrence VA. Ethnicity and Race Variations in Receipt of Surgery among Veterans with and without Depression. Depress Res Treat. 2011;2011:370962. Epub 2011 Oct 12. PubMed PMID: 22013518; PubMed Central PMCID: PMC3195438.

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