Use of a specialist cardiology nurse improves patient’s care

A 67-year-old man who had an inferior myocardial infarction (MI) 3 years earlier had a daily medication regimen that included aspirin, 75 mg; atenolol (Nova-Atenol, Tenormin), 50 mg; ramipril (Altace), 2.5 mg; and simvastatin (Zocor), 10 mg. The patient also had regular inhalers to treat chronic obstructive pulmonary disease. At his most recent clinical visit 3 months earlier, he had a body mass index (BMI) of 29.6 kg/m², blood pressure of 146/92 mm Hg, and a cholesterol level of 5.4 mmol/L. He acknowledged smoking 20 cigarettes daily.

The community cardiology nurse issued a recall for him to undergo a review with her. She checked his electrolytes and liver function tests before titrating his ramipril to 10 mg/day (the maximum tolerable dose) and his simvastatin to 40 mg/day. She also referred him to the community’s smoking cessation clinic.

At 3-month follow-up, the patient’s blood pressure had improved to 142/88 mm Hg and his cholesterol level had decreased to 3.8 mmol/L. Although his BMI remained virtually unchanged at 29.5 kg/m², he had stopped smoking.