(P208) A MODEL FOR SECONDARY PREVENTION: NURSE PRACTITIONER RUN CLINIC FOR COMPREHENSIVE AND TIMELY MANAGEMENT OF CARDIOVASCULAR RISK FACTORS

Background: While secondary prevention treatment options for atherosclerotic cardiovascular disease (ASCVD) have increased substantially over the years, significant implementation gaps remain. As a result we implemented a novel model of care, a nurse practitioner (NP) run cardiometabolic clinic, supervised by cardiologists. This was developed based on the hypothesis that a secondary prevention clinic can achieve treatment of ASCVD risk factors in a timely and integrated manner, in collaboration with primary care and specialists.

METHODS AND RESULTS: In Hamilton, Ontario from November 2022 to October 2023, 274 patients were seen (median age 62 [IQR 56-70 years], 72% male). The NP saw patients in person or virtually to provide timely, comprehensive patient-centered care. ASCVD education included verbal instructions, handouts, videos and demonstrations to enhance disease knowledge and management strategies. The NP referred to allied health for additional support, as needed. 85% of patients were referred for coronary artery disease (CAD), followed by cerebrovascular disease or peripheral artery disease. At first visit, uncontrolled risk factors were, dyslipidemia (57% [157/274] LDL-C >1.8 mmol/L), obesity (50% [136/274] BMI >30kg/m2), hypertension (46% [125/274] blood-pressure >130/80),  type II diabetes (39% [107/274] HbA1c >6.5%), current smokers (20% [54/274]), chronic kidney disease (16% [43/274] eGFR < 60 mL/min/1.73m2, albumin-creatinine ratio >3mg/mmol) and depression (6% [15/274] PHQ-2 > 3). We noted that 35% (95/274) of patients had a family history of premature CAD and 75% (206/274) had >2 uncontrolled risk factors.
At initial consultation, 56% (154/274) of patients had pharmacologic intervention, most commonly for dyslipidemia (45% [124/274]), followed by diabetes (10% [28/274]), hypertension (9% [25/274]) and smoking cessation (5% [15/274]). Common pharmacological interventions were change in statin dose (40% [49/124]), ezetimibe (31% [38/124]), icosapent-ethyl (20% [25/124]), PCSK9i (36% [45/124]), GLP1-agonist (50% [14/28]), SGLT2i (25% [7/28]), varenicline (53% [8/15]), and nicotine- replacement-therapy (53% [8/15]).
Among patients with LDL-C > 1.8 mmol/L, average LDL-C at visit one was 3.10 mmol/L, 2.39 mmol/L at visit two, 2.12 mmol/L at visit three, 1.85 mmol/L at visit four and 1.69 mmol/L at visit five.
As of March 8th 2024, 1417 patient visits were conducted and 599 new consultations were completed in the cardiometabolic clinic.

Conclusion: Uncontrolled risk factors are common in ASCVD. An NP run clinic (supervised by cardiologists) dedicated to risk factor modification can improve secondary prevention through use of evidence-based treatments in a stepwise, integrated approach. The NP model reduces care silos, addresses multiple risk factors, and bridges gaps arising from current models of specialty and primary care.