Text: Pramila Gaudel
Photo: Prakash K.C.

Good results from counselling patients with coronary artery disease

Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Unhealthy lifestyle habits are fundamental risk factors of CAD that require more emphasis and focus. Incidence of cardiovascular events among CAD patients can be reduced with positive lifestyle changes. Improving patients’ health by increasing their adherence to healthy habits is a major challenge that requires significant effort. Effective interventions to modify unhealthy lifestyle and improve patients’ health must be identified and implemented, especially for patients with limited access to a healthcare facility.

The research conducted by Pramila Gaudel at Tampere university as a doctoral candidate aimed to gain insight into the prevalence of modifiable risk factors and to investigate the effect of a nurse-led lifestyle modification intervention among CAD patients.

Seven modifiable lifestyle-related risk factors were studied simultaneously among 224 CAD patients in Nepal. The studied modifiable risk factors were unhealthy diet, physical inactivity, overweight or obesity, perceived stress, non-adherence to medication, smoking, and alcohol consumption.

Nurse-led lifestyle counselling intervention was developed and implemented in this study with the help of audio-visual aids. Counselling was supplemented with informative pictorial pamphlets on the modification of habits causing health risks. Of the 224 total study participants, 112 patients in the intervention group received structured intervention plus the usual care provided by a hospital. A total of 112 patients in the usual care group received short verbal information plus the hospital’s usual care.

Six different standard instruments were used to collect data on studied lifestyle variables. The same instruments were used to collect data at baseline, one-month, and six-month follow-ups.

The findings of the study, based on self-reported data, showed a high prevalence of multiple lifestyle-related risk factors among the studied patients, with stress being the most prevalent and current alcohol consumption the least. Male patients and patients with a high income had higher odds of being in the medium- and high-risk groups respectively. A general linear model repeated measure analysis showed a greater improvement in lifestyle-related risk factor habits in the intervention group compared with the usual care group. The effects were statistically significant for dietary habits, physical activity, medication adherence, and perceived stress at one-month and six-month follow-ups. More cardiac events were reported in the usual care group than in the intervention group at the follow-ups. Compared to the baseline, a greater change in lifestyle habits was found after one month than after six months of the intervention.

The results of this study added insights on effectiveness of nurse led counselling intervention on reducing health risk behaviour of patients with CAD in low-and middle-income countries settings.

More extensive and longer-term experimental research among a larger population is receommended to generalise the effectiveness of the intervention for healthy lifestyle modification.

In 2022 Pirkanmaa Regional Fund awarded M.Sc. Pramila Gaudel a grant for evaluating the effect of lifestyle modification intervention on CAD patient's adherence to lifestyle changes in Nepal.