Six RCTs (n=3,939) met the inclusion criteria (the interim and final analysis of one was reported separately, thus 5 individual RCTs were included in the review).
Measures of anxiety and depression were improved in 2 studies that evaluated nurse-led clinics, whereas 2 studies that compared general practitioner (GP) clinics with nurse-led clinics showed no statistically significant difference in anxiety or depression.
Satisfaction in patients awaiting CABG was higher with nurse-led clinics (1 study); no comparison was made with GP care.
Angina symptoms were reduced in 3 studies: 1 study found improved physical limitations and number of attacks following the provision of a nurse-led structured Angina Plan and educational session, while 2 studies comparing nurse-led clinics with GP care found a reduction in exercise-induced angina and fewer patients who reported worsening of angina, respectively.
An assessment of general health status using the SF-36 instrument (2 studies) showed that nurse-led clinics were associated with statistically significant improvements compared with GP care in all domains, with the exception of mental health, energy and vitality (1 study). There was evidence of statistical heterogeneity in some of the domains assessed.
Blood-pressure was improved in nurse-led clinics compared with GP care, with a higher percentage of untreated hypertensive participants associated with GP care (1 study). No significant difference was found in the number of untreated hypertensive participants between specialist cardiac care and GP care (1 study).
Cholesterol levels in patients awaiting CABG were significantly reduced in patients receiving nurse-led care compared with GP care (1 study).
Prescribing of antiplatelets (1 study) and cholesterol agents (2 studies) was increased in patients receiving nurse-led and GP care. Untreated hypertension was apparent in 19% of patients in both nurse-led and GP care groups (1 study).
In terms of lifestyle, 1 study comparing nurse-led clinics with usual care in patients awaiting CABG showed improved body mass index, amount of activity and reduced levels of smoking, favouring the nurse-led clinic. One study comparing specialist cardiac nurse care with GP care showed no difference in diet or levels of smoking. One study comparing a nurse-led Angina Plan with an educational session showed improved dietary intake and amount of activity, favouring the Angina Plan. One study comparing nurse-led and GP clinics showed a reduced level of smoking.
One study comparing a specialist cardiac nurse-led clinic with GP care showed an increase in follow-up in both groups, with twice as many patients in the nurse-led clinic attending follow-up.
Admission rates between nurse-led and GP care were reported in 2 studies, one favoured nurse-led clinic and the other showed no difference between nurse-led and GP care.