1. The Role of the Cardiovascular Nurse Alison de Vries
Good afternoon
Firstly I’ll give you a bit of background as to how my job came about
THEN go on to tell you about how the clinic runs, types of patients I see at the clinic and finally look at other aspects of my role

2. Background Established 2004 funded from the Big Lottery
Pilot project for 3 years
Open access 24hr ABPM service
Nurse led hypertension clinic
Based at Ward 6, A.R.I
I started in post in following a grant application to the Big Lottery fund to set up and run open access ABPM service and the nurse led clinic hypertension clinic based in Ward.
Orginally a pilot project for 3 years at the end of the project we successfully secured on-going to continue the service from the Stroke MCN

3. Aims of the clinic
One stop comprehensive cardiovascular risk assessment
Collaboration with primary care to reduce cardiovascular risk
Short waiting times
Prompt access for ABPM service
To collate data on patient outcomes
The clinic provides a one stop comprehensive risk assessment for patients referred to secondary care with hypertension or the possible diagnosis of hypertension
I liase closely with the primary health care team in the management of these patients so as to
optimise cardiovascular risk reduction in the FOR PRIMARY PREVENTION OF STROKE
THE CLINIC AIMS to maintain short waiting times for these patients such that since the introduction of this service waiting times have reduced from around 10 weeks to 2-3 weeks
AND IT provides prompt DIRECT access for GP’s for out-patient ambulatory blood pressure monitoring and provide a report on the blood pressure readings to the referring GP WHERE THE GP CAN REFER DIRECTLY FOR THIS INVESTIGSTIONS
AND I collect data on patient outcomes from the patients attending the hypertension clinic

4. Types of referrals Direct referrals for 24hr ABPM service
To establish diagnosis of hypertension
Drug intolerance
Resistant hypertension
Young patients
To exclude secondary causes
SO WHAT KIND OF PATIENTS DO I SEE IN WARD 6
I see patients who are referred for out-patient ambulatory blood pressure monitoring
The monitor is fitted and when it is returned and the blood pressure readings are obtained FROM THE MACHINE I report back to the GP with recommendations on the management of the patients blood pressure.
THE TYPES OF REFERRALS WHICH ARE SEEN AT THE NURSE-LED HYPERTENSION CLINIC are assessed
To establish diagnosis of hypertension – in patients who have variable blood pressure recorded at the practice or have a suspected white coat response these patients are assessed and a 24hr ABPM is useful for making a definite diagnosis
Drug intolerance – patients who have had multiple adverse effects to
medication are referred for advice on medication
Patients are resistant hypertension these are patients who are
taking several anti-hypertensive medications and their blood pressure remains
Poorly controlled
Young patients – under age of 30
If there is question that there is a secondary cause
for example:primary aldosteronism, phaeochromocytoma, renal artery stenosis

5. How is the clinic run? 1 nurse supported by 3 consultant physicians
Full cardiovascular assessment
Investigations arranged
Management plan – initiation/change of drug therapy, lifestyle advice, follow-up arrangements
Written communication with GP
Patient database
So how is the clinic set up?
The clinic comprises 1 nurse and 3 consultant physicians
Each patient has a full cardiovascular assessment which involves taking thepatient’s medical history, social history and relevant family history with documentation of currentmedication noting any previous adverse drug reactions
THEN
A full cardiovascular examination including fundoscopy , blood pressure recording, height,weight, caluculation of 10yrCVD risk using Joint British Societies computer program If there is as suspicion of white coat hypertension or if patients are experiencing symptoms suggestive of hypotension then 24hr ambulatory blood pressure monitoring may be indicated
Further investigations are then arranged as appropriate echocardiogram
Renal ultrasound Renin/aldosterone blood sampling to exclude primary aldosteronsim and 24hr urine collections
PREVALENCE OF RAS = 3-4%,ALDOSTERONISM 1-15%,PHAEO <0.5%
Once all the relevant assessments carried out and appropriate investigations
management plan is devised initiation/change of drug therapylifestyle advice given on diet,exercise,smoking cessation, follow up arrangements made
Write to GP
Data then entered into patient database

6. Educational role Teaching sessions for practice nurses
GP fellowship training
Advice/support for primary care staff
As well as my clinical role I also have an educational role and provide teaching sessions for practice nurses
STANDARDISED CARE
Resource pack for CVD in practices

7. Research and audit
Improving diagnosis of hypertension (pulse wave analysis)
Satisfaction surveys
Patient outcome data
Also involved in research and audit
EXPLAIN SYPGHMAGOR

8. Questions?