We read with great interest a recent article entitled ‘Secondary prevention and cardiovascular care across Europe: a survey of European Society of Cardiology members’ views’. In this survey of 479 healthcare professionals from eight countries, the main barriers identified were lack of available cardiac rehabilitation programmes and long-term follow-up, patients’ disease perception and professional attitudes towards prevention. Barriers to prevention varied based on the survey participants’ country of origin; however, there was consensus across all countries on the three most important strategies to improve prevention, namely multidisciplinary interventions, patient education and introducing performance measures. In the UK, shortcomings in the delivery of secondary prevention programmes have also been linked with suboptimal outcomes for patients with cardiovascular disease (CVD), and recently a group of multidisciplinary team (MDT) members working in secondary prevention in primary and secondary care settings has developed a UK consensus on optimising CVD secondary prevention care. As co-authors of the UK consensus statement, we were mindful that there is not a uniform, one-size-fitsall model of CVD secondary prevention care, and that within our National Health Service (NHS), the roles undertaken by different MDT members can vary depending on the skillsets and healthcare resources available locally. Within the typical management pathway for post-myocardial infarction follow-up, numerous opportunities for MDT members to deliver secondary prevention care from the time of initial presentation and hospitalisation through to long-term post-discharge follow-up were identified and outlined. In addition, a range of best practice models from across the UK that are currently achieving success in reducing cardiovascular risk were described and endorsed with a view to being adopted or adapted elsewhere. These included a pharmacist-led, hospital-based post-myocardial infarction medicines optimisation programme, a nurse-led integrated community-based CVD prevention programme and a GP-led one-stop heart failure diagnosis and management clinic model for primary care. All of these models provide practical examples of ways that different healthcare professionals involved in delivering MDT care can work together to improve patients’ outcomes in CVD, for example through recognising and addressing poor adherence to cardioprotective medication. The data analysis from Fitzsimons et al. underlines that secondary prevention is often suboptimal across the European countries included in the European Society of Cardiology (ESC) survey. Given that MDT members are central to delivering CVD secondary care, it is understandable that an Association of Cardiovascular Nursing and Allied Professions (ACNAP) task force is currently examining ways to support greater collaboration between allied professions and to address uncertainties about the roles that different MDT members can play in CVD secondary prevention. We suggest that the UK consensus statement (which is available online as an open-access publication) may provide insights and practical guidance which are of interest to cardiovascular nurses and MDT members working in CVD secondary care across Europe.

中文翻译：

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优化整个欧洲的二级预防和心血管护理：英国对共同目标的看法

我们饶有兴趣地阅读了最近一篇题为“整个欧洲的二级预防和心血管护理：欧洲心脏病学会成员观点调查”的文章。在对来自 8 个国家的 479 名医疗保健专业人员进行的这项调查中，确定的主要障碍是缺乏可用的心脏康复计划和长期随访、患者的疾病认知和对预防的专业态度。预防障碍因调查参与者的原籍国而异；然而，所有国家就改善预防的三个最重要战略达成了共识，即多学科干预、患者教育和引入绩效措施。在英国，二级预防计划实施中的缺陷也与心血管疾病 (CVD) 患者的次优结果有关，最近，在初级和二级保健机构中从事二级预防工作的一组多学科团队 (MDT) 成员达成了英国共识优化心血管疾病二级预防护理。作为英国共识声明的合著者，我们注意到没有统一的、一刀切的 CVD 二级预防保健模型，并且在我们的国家卫生服务 (NHS) 中，不同 MDT 成员所承担的角色可能因当地可用的技能组合和医疗保健资源而异。在心肌梗死后随访的典型管理途径中，确定并概述了 MDT 成员从初次就诊和住院到出院后长期随访提供二级预防护理的众多机会。此外，还描述并认可了英国各地目前在降低心血管风险方面取得成功的一系列最佳实践模型，以期在其他地方采用或改编。其中包括由药剂师主导、以医院为基础的心肌梗塞后药物优化计划、护士主导的综合社区 CVD 预防计划和全科医生主导的一站式心力衰竭诊断和管理初级保健诊所模式。所有这些模型都提供了实际示例，说明参与提供 MDT 护理的不同医疗保健专业人员可以共同努力改善 CVD 患者的结果，例如通过识别和解决对心脏保护药物依从性不佳的问题。Fitzsimons 等人的数据分析。强调在欧洲心脏病学会 (ESC) 调查中所包括的欧洲国家，二级预防通常是次优的。鉴于 MDT 成员是提供 CVD 二级护理的核心，可以理解的是，心血管护理和相关专业协会 (ACNAP) 工作组目前正在研究支持相关专业之间加强合作的方法，并解决不同 MDT 角色的不确定性会员可以在CVD二级预防中发挥作用。