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Learn more: PMC Disclaimer | PMC Copyright Notice J Cardiovasc Nurs . 2025 Jul 7;41(3):209–216. doi: 10.1097/JCN.0000000000001234 Search in PMC Search in PubMed View in NLM Catalog Add to search Impact of Nurse-Led Cardiovascular Risk Assessment and Management Program on 1-Year Outcomes in Patients on Hemodialysis Post Percutaneous Coronary Intervention Wanting Zhao Wanting Zhao 1 Wanting Zhao, Department of Cardiac Rehabilitation Center, Capital Medical University Affiliated Beijing Rehabilitation Hospital, China. Find articles by Wanting Zhao 1 , Weiqiu Zhao Weiqiu Zhao 2 Weiqiu Zhao, Department of Blood Purification Center, Capital Medical University Affiliated Beijing Rehabilitation Hospital, China. Find articles by Weiqiu Zhao 2 , Xiaodan Sun Xiaodan Sun , MM 3 Xiaodan Sun, MM, Department of Blood Purification Center, Capital Medical University Affiliated Beijing Rehabilitation Hospital, China. Find articles by Xiaodan Sun 3, ✉ Author information Article notes Copyright and License information 1 Wanting Zhao, Department of Cardiac Rehabilitation Center, Capital Medical University Affiliated Beijing Rehabilitation Hospital, China. 2 Weiqiu Zhao, Department of Blood Purification Center, Capital Medical University Affiliated Beijing Rehabilitation Hospital, China. 3 Xiaodan Sun, MM, Department of Blood Purification Center, Capital Medical University Affiliated Beijing Rehabilitation Hospital, China. ✉ Correspondence: Xiaodan Sun, MM No. 13, Gate 1, Building 2, Courtyard 3, Dongan St, Fengtai Town, Fengtai District, Beijing 101199, China ( [email protected] ). ✉ Corresponding author. Issue date 2026 May-Jun. Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. PMC Copyright notice PMCID: PMC13064831 PMID: 40619611 Abstract Background: Cardiovascular complications are a major concern for hemodialysis patients with chronic kidney disease, especially post percutaneous coronary intervention (PCI). The authors of this study investigated the impact of a nurse-led cardiovascular risk assessment and management program on 1-year outcomes in these patients. Methods: A retrospective secondary analysis was conducted on the data of 267 patients receiving hemodialysis due to chronic kidney disease who underwent PCI. The data of patients were divided into a nurse-led care group (n = 129) receiving nurse-led care and a usual care group (n = 138) receiving usual care. The nurse-led group received personalized treatment, health education, psychological support, skill training, and regular follow-ups over 1 year. Assessments of cardiovascular risk, laboratory characteristics, psychological status, quality of life (Short Form 36 Health Survey Questionnaire), and major adverse cardiovascular events were conducted at discharge and after 1 year. Results: At 1 year, the nurse-led care group showed greater reductions in cardiovascular risk compared with the usual care group. The levels of serum creatinine, uric acid, and blood lipid in the nurse-led care group were significantly improved. Psychological assessments revealed reduced anxiety and depression scores in the nurse-led care group. Short Form 36 Health Survey Questionnaire quality of life scores were higher in the nurse-led care group in several domains. The incidence of major adverse cardiovascular events, particularly cardiogenic shock, was significantly reduced in the nurse-led care group, Conclusion: Nurse-led cardiovascular risk management significantly improves cardiovascular risk profiles, psychological health, and quality of life, while reducing major adverse cardiovascular event incidence in patients receiving hemodialysis due to chronic kidney disease post PCI. Keywords: cardiovascular disease, chronic kidney failure, hospital nursing staff, percutaneous coronary intervention, risk assessment What’s New and Important Authors of a retrospective study analyzed the impact of a nurse-led cardiovascular risk management program on 267 hemodialysis patients with CKD post PCI, comparing it with standard care. The nurse-led care group showed significant improvements in cardiovascular risk reduction, biochemical markers, psychological status, and quality of life, as assessed by the Short Form 36 Health Survey Questionnaire. The incidence of major adverse cardiovascular events was lower in the nurse-led care group, notably reducing cardiogenic shock occurrences, highlighting the effectiveness of personalized nursing interventions. Cardiovascular disease remains a leading cause of morbidity and mortality globally, presenting a significant burden on healthcare systems. 1 , 2 The risk of cardiovascular complications in patients with chronic kidney disease (CKD) is extremely high, at least 5 times that of the general population. 3 , 4 The main risk factors for the progression of cardiovascular disease include traditional risk factors and CKD-specific risk factors. 5 Traditional risk factors such as hypertension, diabetes, dyslipidemia, smoking, and family history are more prevalent in the population with CKD. 6 , 7 Moreover, CKD-specific risk factors also play a significant role. In patients with CKD, impaired kidney regulation of sodium and water causes hypertension, which increases vascular pressure. 8 Abnormal calcium (Ca)-phosphorus metabolism causes vascular calcification, reducing elasticity. 9 Anemia increases cardiac workload, potentially causing heart failure. 10 In addition, elevated inflammatory factors harm vascular endothelial cells and accelerate the development of atherosclerosis. 4 Percutaneous coronary intervention (PCI) is a critical treatment for coronary artery disease, but patients with CKD on hemodialysis face unique challenges because of an increased risk of adverse cardiovascular events. In a meta-analysis, approximately 67% of patients ultimately received PCI treatment. 11 These patients often have severe coronary artery calcification, occlusive, and complex lesions, requiring higher doses of contrast agents during PCI, further worsening their condition. 12 – 15 Nurse-led interventions, characterized by comprehensive patient education, risk assessment, and management protocols, have demonstrated promising results in various clinical settings. These interventions leverage the continuity of care and accessibility inherent to the nurse-led care profession, thereby facilitating sustained patient engagement and adherence to recommended lifestyle modifications and pharmacotherapy. 16 – 18 Despite the increasing recognition of nurse-led models in chronic disease management, their application in cardiovascular care for hemodialysis patients post PCI remains underexplored. 19 – 21 In this study, our aim was to evaluate the impact of a nurse-led cardiovascular risk assessment and management program on long-term outcomes in this vulnerable cohort. Key questions include: How does the program affect cardiovascular risk in patients with CKD post PCI? What are its effects on renal and cardiac function? Does it improve mental health and quality of life? Can it significantly reduce major adverse cardiovascular events? Materials and Methods Ethics Statement This study was approved by the ethics committee of Capital Medical University Affiliated Beijing Rehabilitation Hospital (2021-BJ-618) and adhered to the guidelines established in the Declaration of Helsinki. 22 Study Design The primary study was an observational study conducted at Capital Medical University Affiliated Beijing Rehabilitation Hospital from January 2019 to December 2022. The aim of this primary study was to collect comprehensive clinical data of patients undergoing hemodialysis for CKD and receiving PCI treatment. The data covered various aspects, including basic demographic information, detailed disease diagnoses, treatment process records, results of various laboratory tests, and details of nursing interventions. This provided a rich data foundation for the subsequent secondary analysis. This study is a retrospective secondary analysis, in which we retrospectively analyzed the data from 267 patients who received PCI and hemodialysis at Capital Medical University Affiliated Beijing Rehabilitation Hospital from January 2019 to December 2022. The data were collected from the medical record system of the primary study and supplemented it through regular follow-ups. During the screening process, we collected a total of 310 medical records. After rigorous screening according to the inclusion and exclusion criteria, 43 records were excluded for not meeting the standards, including nine cases of patients lost to follow-up. Ultimately, the data of 267 patients were included in this study. The patients’ data were divided into 2 groups: the nurse-led care group, consisting of the data of 129 patients who received nurse-led cardiovascular risk management, and the usual care group, consisting of the data of 138 patients who did not receive this specific management. The medical records of these patients’ data were analyzed to evaluate cardiovascular risk, renal function indicators, psychological status, quality of life, and the incidence of major adverse cardiovascular events. Eligibility and Grouping Criteria Inclusion criteria for this study were as follows: participants were required to be older than 18 years; they must have been given a diagnosis of coronary artery disease and undergone PCI in alignment with the management guidelines for coronary artery disease established by the American Heart Association and the American College of Cardiology 23 ; they must have been given a diagnosis of severe renal insufficiency as per the management guidelines for kidney disease outlined by the European Renal Best Practice, 24 corresponding to CKD stages 4 and 5; complete medical records and data are required; and patients must own a mobile phone to facilitate follow-up communication. Different languages and dialects do not pose barriers to participation in the project. The exclusion criteria were defined as follows: a glomerular filtration rate exceeding 30 mL/min/1.73 m 2 ; unsuccessful PCI procedure; the presence of autoimmune diseases; a history of renal transplantation; missing creatinine level data upon admission; admission due to acute heart failure or out-of-hospital cardiac arrest; a history of PCI procedure or cardiovascular surgery; treatment with percutaneous cardiopulmonary support or bilateral approach for chronic total occlusion; the need for hemodialysis due to conditions such as uremia, severe malnutrition, drug and food poisoning, severe metabolic acidosis, hyperkalemia, hypercalcemia, hypocalcemia, or hyperphosphatemia; presence of cognitive or motor dysfunction; deafness; undergoing radiotherapy during the follow-up period; and being lost to follow-up within 1 year. Description of Patient Management and Nursing Interventions In the original medical record system, the nursing team made clear and standardized records of the type of nursing intervention for each patient. During the data collation stage, the research team determined the grouping by carefully reviewing each medical record based on the nursing record content. If the medical record shows that the patient has received a personalized nursing plan based on cardiovascular risk stratification, the patient’s data will be classified into the nurse-led care group; if the record only presents basic routine nursing service content, the data will be included in the usual care group. For all patients, at both discharge after PCI, nurses used the China-PAR risk assessment model, 25 developed by the National Center for Cardiovascular Disease, to evaluate the risk of atherosclerotic cardiovascular disease. This model provides a quantitative estimate of the patient’s cardiovascular risk by comprehensively assessing several factors, including the patient’s age, gender, blood pressure, lipid levels, smoking history, and diabetes status. The usual care group received usual care, which included dietary advice, psychological support, and routine health education. Discharged 1 week after PCI, they were provided with appropriate instructions and informed of necessary precautions. Nurses conducted follow-ups every 3 months to inquire about and document any major adverse cardiovascular events. One year post PCI, all patients returned to the hospital for a follow-up examination. In contrast, the nurse-led care management group benefited from comprehensive nurse-led care interventions tailored to each patient’s cardiovascular risk assessment. Plan A For patients with cardiovascular risk below 25%, during the 1-week hospital stay, each morning after basic treatments, a group health education session is conducted. These sessions use various methods such as lectures, PPT presentations, face-to-face interactions, and specific flyers to disseminate knowledge. The sessions begin with addressing common questions collectively, followed by individual responses to specific needs. The flyers for plan A patients focus on basic prevention knowledge of cardiovascular disease. Nurses communicate with patients daily to meet their basic needs; reduce anxiety, depression, and panic; and improve treatment adherence. Patients are educated about the risk factors for cardiovascular disease and receive general knowledge about cardiovascular disease. After discharge, patients receive weekly follow-up calls and off-site follow-ups every 6 months to guide daily care and medication knowledge, provide psychological counseling, and alleviate anxiety and depressive symptoms. Plan B For patients with cardiovascular risk between 25% and 30%, during a 1-week hospital stay, health education is provided twice daily through lectures, PPT presentations, face-to-face interactions, and flyers. In addition to the basic content, the flyers for plan B patients also detail emergency management and medication use. In the morning, routine knowledge dissemination and successful recovery case studies are shared. In the afternoon, multimedia equipment is used to play videos on emergency response for cardiovascular disease. Patients in the same ward are divided into small groups to discuss the video content and practice emergency skills, promoting communication and learning among patients and making full use of the ward space. Nurses communicate with patients twice daily, educating them about the risk factors for cardiovascular disease, providing general knowledge about cardiovascular disease, explaining relevant cardiovascular disease tests and their necessity, and teaching patients emergency response methods for cardiovascular emergencies, including cardiopulmonary resuscitation and the use of automated external defibrillators. Their psychological needs are addressed to reduce anxiety, depression, and feelings of panic. After discharge, patients receive 2 telephone follow-ups per week and off-site follow-ups every 3 months. The aim is to monitor negative emotions, provide timely psychological counseling, recommend appropriate physical activities, monitor medication adherence and the patient’s condition regarding cardiovascular disease, and promptly discourage any unhealthy behaviors. Plan C For patients with cardiovascular risk above 30%, during a 1-week hospital stay, health education is provided 3 times daily through lectures, powerpoint presentations, face-to-face interactions, and flyers. These sessions are scheduled at different times to ensure individual attention during explanations. The flyers for plan C patients are more personalized, including care for complications and rehabilitation suggestions. Psychological counseling is conducted in private settings or at appropriate times. Nurses communicate with patients 3 times daily, addressing their psychological needs and customizing different lifestyle and dietary patterns for each patient. Patients are educated about the risk factors for cardiovascular disease; provided with general knowledge about cardiovascular disease; informed about relevant cardiovascular disease tests and their necessity; taught emergency response methods for cardiovascular emergencies, including cardiopulmonary resuscitation and the use of automated external defibrillators; and advised to undergo relevant cardiovascular disease tests. For patients who have undergone relevant cardiovascular disease tests and have been given a diagnosis of a condition, a treatment plan is formulated. After discharge, patients receive 4 telephone follow-ups per week and off-site follow-ups once a month. Each telephone follow-up inquires about the patient’s medication use, dietary habits, physical activity, and emotional changes. The patient’s diet is summarized weekly, and lifestyle and dietary patterns are adjusted in a timely manner based on the patient’s condition. Psychological counseling is provided weekly to relieve stress and help patients achieve a more relaxed state of mind. Patients are recommended to undergo relevant cardiovascular disease tests every 6 months, and their test results are monitored in real time, with treatment plans being formulated accordingly. During phone follow-ups, patient-reported adverse events were recorded, and patients with abnormalities were advised to seek hospital review. Nurses also monitored major cardiac events (eg, myocardial infarction [MI], cardiogenic shock, heart failure) to evaluate cardiovascular status. One year post PCI, all patients returned for follow-up. Blood Sample Measurement Before discharge after PCI and at the 1-year follow-up, all patients underwent an overnight fast. A 4-mL blood sample was then collected to assess various blood indices. On the same day, serum and plasma were separated and analyzed using a Beckman Coulter AU680, a fully automatic biochemical analyzer from the United States. This analysis measured lipid profiles, serum creatinine (SCR), uric acid (UA), albumin, prealbumin, phosphorus, and alkaline phosphatase. Trace elements, such as Ca, were measured using an atomic absorption spectrophotometer (AA800, Beijing Jingke Ruida Technology Co, Ltd, Beijing, China). The levels of plasma proteins, ferritin, parathyroid hormone (PTH), and 25-hydroxyvitamin D [25(OH)D] were determined using a fully automatic chemiluminescence immunoanalyzer (HISCL-800, SYSMEX, Kobe City, Japan). Psychological Status Assessment At discharge after PCI and at the 1-year follow-up, nurses evaluated the psychological state of patients using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS), which have Cronbach α values of 0.897 and 0.73, respectively. 26 , 27 Initially, patients completed self-assessments, after which nurses converted the raw scores into standard scores. According to domestic evaluation criteria, an SAS standard score greater than 50 indicates a state of anxiety, whereas an SDS standard score greater than 53 signifies depressive symptoms. Health Status Assessment At discharge after PCI and at the 1-year follow-up, nurses assessed the health status of patients using the Short Form 36 Health Survey Questionnaire, which boasts a Cronbach α greater than 0.85. 28 This questionnaire encompasses 8 dimensions: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. Each dimension was scored on a scale from 0 to 100, where higher scores indicate a better quality of life. Statistical Analysis The data analysis was conducted using SPSS version 29.0 (SPSS Inc, Chicago, Illinois). The Shapiro-Wilk test was adopted to test normal distribution; normally distributed measures were depicted as mean ± standard deviation and analyzed by the independent samples t test between the 2 groups. Nonnormally distributed measures were depicted as median (25th percentile, 75th percentile) and analyzed by the Mann-Whitney U test between the 2 groups. Counting data were depicted as the number of instances and the percentage and analyzed by the χ 2 test. A P value of less than .05 was considered statistically significant. Results Sample Demographics and Characteristics A total of 267 patients were included in the study, with 129 patients in the nurse-led care group and 138 patients in the usual care group. There were no significant differences between the 2 groups in terms of gender, mean age, body mass index, marital status, education level, smoking history, dialysis duration, and previously diagnosed conditions such as MI, heart failure, diabetes mellitus, cerebrovascular disease, peripheral artery disease, chronic lung disease, and hypertension (all P s > .05) (Table 1 ). Furthermore, indicators for PCI, including ST-elevation MI, unstable angina/non–ST-elevation MI, and elective PCI, exhibited similar distributions in both groups ( P = .964). Overall, the demographic parameters indicated a balanced baseline between the usual care group and the nurse-led care group. In the nurse-led care group, 25 individuals implemented plan A, 40 individuals implemented plan B, and 64 individuals implemented plan C. Eighty-seven patients underwent relevant cardiovascular disease examinations, among whom 21 were given a diagnosis of additional cardiovascular disease. Two patients adopted a lifestyle change plan, 16 received medication treatment, and 3 underwent surgical treatment. All patients in the usual care group received usual care (Table 2 ). TABLE 1. Sample Demographics and Characteristics Parameters Usual Care Group (n = 138) Nurse-Led Care Group (n = 129) t /χ 2 P Male/female 96 (69.57%)/42 (30.43%) 87 (67.44%)/42 (32.56%) 0.139 .709 Age, y 58.57 ± 9.18 59.14 ± 9.62 0.494 .622 Body mass index, kg/m 2 22.76 ± 3.26 22.94 ± 3.69 0.430 .668 Marital status, yes/no 125 (90.58%)/13 (9.42%) 119 (92.25%)/10 (7.75%) 0.236 .627 Education 0.148 .929 Elementary 21 (15.22%) 19 (14.73%) High school 76 (55.07%) 74 (57.36%) College 41 (29.71%) 36 (27.91%) Current smoker/nonsmoker 38 (27.54%)/100 (72.46%) 31 (24.03%)/98 (75.97%) 0.427 .513 Dialysis duration, y 3.33 ± 0.84 3.20 ± 0.72 1.401 .162 Myocardial infarction 37 (26.81%) 36 (27.91%) 0.04 .841 Heart failure 35 (25.36%) 32 (24.81%) 0.011 .917 Diabetes mellitus 103 (74.64%) 97 (75.19%) 0.011 .917 Cerebrovascular disease 14 (10.14%) 12 (9.3%) 0.054 .816 Peripheral artery disease 32 (23.19%) 27 (20.93%) 0.198 .657 Chronic lung disease 1 (0.72%) 2 (1.55%) 0.003 .953 Hypertension 88 (63.77%) 75 (58.14%) 0.888 .346 Dyslipidemia 97 (70.29%) 93 (72.09%) 0.106 .745 Three-vessel disease 52 (37.68%) 49 (37.98%) 0.003 .959 PCI indications 0.072 .964 ST-elevation MI 18 (13.04%) 16 (12.4%) Unstable angina/non–ST-elevation MI 62 (44.93%) 60 (46.51%) Elective PCI 58 (42.03%) 53 (41.09%) Open in a new tab Abbreviations: MI, myocardial infarction; PCI, percutaneous coronary intervention. TABLE 2. Nurse-Led Care Group’s Nursing Plan Nursing Methods Nurse-Led Care Group (N = 129) Plan A 25 Plan B 40 Plan C 64 Conducting cardiovascular-related examinations 87 Given a diagnosis of cardiovascular disease 21 Treatment plan Lifestyle changes 2 Medication treatment 16 Surgical treatment 3 Open in a new tab Cardiovascular Risk At discharge after PCI, there were no statistically significant differences in cardiovascular risk levels between the usual care group and the nurse-led care group ( P = .280) (Table 3 ). However, at the 1-year follow-up, the nurse-led care group exhibited a notably greater reduction in cardiovascular risk levels compared with the usual care group ( P = .003). The change in cardiovascular risk from discharge to 1-year follow-up was significantly more pronounced in the nurse-led care group compared with the usual care group ( P = .003), indicating the effectiveness of the nurse-led cardiovascular risk assessment and management program. TABLE 3. Changes in Cardiovascular Risks After Percutaneous Coronary Intervention and at 1-Year Follow-up Variable Usual Care Group (n = 138) Nurse-Led Care Group (n = 129) t P Cardiovascular risks at discharge after PCI, % 32.72 ± 3.58 32.21 ± 4.13 1.083 .280 Cardiovascular risks at 1-year follow-up, % 28.77 ± 3.49 27.25 ± 4.63 3.014 .003 Changes in cardiovascular risks, % 3.96 ± 0.84 4.45 ± 1.68 3.022 .003 Open in a new tab Abbreviation: PCI, percutaneous coronary intervention. Renal Function Indicators At discharge, the comparison of renal function indicators between the 2 groups revealed no significant differences in SCR, UA, hemoglobin, albumin, ferritin, prealbumin, PTH, phosphorus, and 25(OH)D levels between the usual care group and the nurse-led care group (all P s > .05) (Table 4 ). These findings suggest equivalence in renal function indicators at discharge between both groups. TABLE 4. Comparison of Renal Function Indicators Between the 2 Groups at Discharge and 1-Year Follow-up Variable Usual Care Group (n = 138) Nurse-Led Care Group (n = 129) t P At discharge SCR, μmol/L 203.15 ± 25.36 201.75 ± 24.97 0.455 .650 UA, μmol/L 426.71 ± 131.37 433.65 ± 129.75 0.434 .665 Hb, g/dL 7.91 ± 1.32 8.03 ± 1.27 0.784 .434 ALB, g/dL 3.57 ± 0.67 3.61 ± 0.83 0.521 .603 Ferritin, ng/mL 167.75 ± 29.37 169.18 ± 30.25 0.392 .695 Prealbumin, mg/dL 28.39 ± 3.98 28.12 ± 3.74 0.572 .568 PTH, pmol/L 15.69 ± 4.56 15.27 ± 4.72 0.738 .461 P, mmol/L 2.85 ± 0.92 2.81 ± 0.87 0.327 .744 25(OH)D, ng/mL 9.36 ± 3.19 9.45 ± 3.46 0.223 .824 At 1-y follow-up SCR, μmol/L 201.26 ± 23.74 193.27 ± 20.72 2.918 .004 UA, μmol/L 391.25 ± 68.74 372.17 ± 72.37 2.209 .028 Hb, g/dL 7.25 ± 1.39 7.13 ± 1.16 0.786 .432 ALB, g/dL 3.72 ± 1.03 3.78 ± 1.12 0.418 .676 Ferritin, ng/mL 163.15 ± 24.78 166.75 ± 26.17 1.155 .249 Prealbumin, mg/dL 29.29 ± 3.18 29.67 ± 3.59 0.919 .359 PTH, pmol/L 12.68 ± 3.84 11.25 ± 3.67 3.113 .002 P, mmol/L 2.12 ± 0.76 1.85 ± 0.73 2.912 .004 25(OH)D, ng/mL 13.87 ± 3.59 15.11 ± 2.96 3.095 .002 Open in a new tab Abbreviations: ALB, albumin; Hb, hemoglobin; P, phosphorus; PTH, parathyroid hormone; SCR, serum creatinine; UA, uric acid; 25(OH)D, 25-Hydroxyvitamin D. One year after follow-up, the nurse-led care group showed significantly lower levels of SCR, UA, PTH, and phosphorus compared with the usual care group (all P s < .05). In addition, the 25(OH)D levels were significantly higher in the nurse-led care group ( P = .002). Other variables, including hemoglobin, albumin, ferritin, prealbumin, did not exhibit statistically significant differences between the groups ( P > .05). These results underscore the effectiveness of nurse-led cardiovascular risk management in improving certain renal function indicators over the course of 1 year. Cardiac Function Indicators At discharge, there were no significant differences between the usual care group and the nurse-led care group in Ca, total cholesterol, low-density lipoprotein, triglycerides, and high-density lipoprotein levels (all P s > .05) (Table 5 ). Overall, the cardiac function indicators evaluated at discharge did not present a significant difference between both groups. TABLE 5. Comparison of Cardiac Function Indicators Between the 2 Groups at Discharge and 1-Year Follow-up Variable Usual Care Group (n = 138) Nurse-Led Care Group (n = 129) t P At discharge Ca, mmol/L 1.87 ± 0.54 1.86 ± 0.62 0.107 .915 TC, mg/dL 214.8 ± 42.19 216.4 ± 43.17 0.304 .762 LDL, mg/dL 142.60 ± 37.15 143.70 ± 36.84 0.245 .807 TG, mg/dL 176.40 ± 41.28 175.80 ± 39.45 0.108 .914 HDL, ng/mL 41.21 ± 10.85 40.36 ± 11.42 0.622 .535 At 1-y follow-up Ca, mmol/L 2.38 ± 0.64 2.59 ± 0.63 2.738 .007 TC, mg/dL 196.35 ± 31.28 186.72 ± 29.81 2.571 .011 LDL, mg/dL 118.08 ± 21.73 110.17 ± 23.57 2.851 .005 TG, mg/dL 158.37 ± 30.42 149.31 ± 31.22 2.402 .017 HDL, ng/mL 46.36 ± 5.14 47.32 ± 4.62 1.615 .108 Open in a new tab Abbreviations: Ca, calcium; HDL, high-density lipoprotein; LDL, low-density lipoprotein; TC, total cholesterol; TG, triglycerides. One year after follow-up, Ca levels were significantly higher in the nurse-led care group compared with the usual care group ( P = .007). Total cholesterol, low-density lipoprotein, and triglyceride levels were also reduced in the nurse-led care group compared with the usual care group (all P s < .05). High-density lipoprotein did not show a statistically significant difference between the 2 groups ( P > .05). These results underscore the effectiveness of nurse-led cardiovascular risk management in improving certain cardiac function indicators over the course of 1 year. Short Form 36 Health Survey Questionnaire Scores At discharge, there were no significant differences between the 2 groups of patients in general health, physical functioning, role physical, bodily pain, role emotional, vitality, social functioning, and mental health scores (all P s > .05) (Table 6 ). These results indicate that the overall quality of life was comparable between the 2 groups at discharge. TABLE 6. Comparison of Short Form 36 Health Survey Questionnaire Scores Between the 2 Groups at Discharge and at 1-Year Follow-up Variable Usual Care Group (n = 138) Nurse-Led Care Group (n = 129) t P At discharge General health 51.36 ± 9.28 52.03 ± 9.37 0.582 .561 Physical functioning 71.09 ± 21.31 70.96 ± 22.01 0.051 .960 Role physical 28.97 ± 10.39 29.18 ± 10.16 0.169 .866 Bodily pain 55.09 ± 15.91 55.19 ± 16.75 0.048 .962 Role emotional 51.38 ± 22.44 52.01 ± 21.92 0.229 .819 Vitality 56.33 ± 12.09 55.26 ± 13.07 0.697 .486 Social functioning 52.21 ± 16.32 51.39 ± 15.27 0.426 .671 Mental health 64.62 ± 16.37 63.99 ± 16.92 0.307 .759 At 1-y follow-up General health 56.89 ± 7.03 59.78 ± 8.29 3.082 .002 Physical functioning 72.38 ± 22.07 80.09 ± 21.31 2.901 .004 Role physical 42.61 ± 11.08 46.69 ± 15.11 2.531 .012 Bodily pain 58.04 ± 16.13 60.21 ± 13.28 1.196 .233 Role emotional 57.07 ± 20.37 62.32 ± 19.04 2.174 .031 Vitality 58.22 ± 10.31 61.27 ± 12.09 2.227 .027 Social functioning 58.88 ± 10.26 62.01 ± 9.07 2.638 .009 Mental health 68.09 ± 12.32 72.82 ± 11.34 0.307 .001 Open in a new tab One year after follow-up, the nurse-led care group reported higher scores in general health, physical functioning, role physical, role emotional, vitality, social functioning, and mental health (all P s < .05). However, there was no significant difference in bodily pain scores ( P = .233). These results suggest the nurse-led program improved quality of life in several aspects over 1 year. Self-Rating Anxiety Scale and Self-Rating Depression Scale Scores At discharge after the PCI procedure, there were no significant differences in SAS scores or SDS scores between the 2 groups (all P s > .05) (Table 7 ). However, at the 1-year follow-up, the SAS and SDS scores in the nurse-led care group were significantly lower than those in the usual care group ( P < .05). These results suggest that nurse-led cardiovascular risk assessment and management had a positive impact on reducing anxiety and depression levels in patients over a 1-year period. TABLE 7. Comparison of Self-Rating Anxiety Scale and Self-Rating Depression Scale Scores Between the 2 Groups at Discharge and 1-Year Follow-up Variable Usual Care Group (n = 138) Nurse-Led Care Group (n = 129) t P At discharge SAS scores 58.27 ± 3.18 57.98 ± 3.59 0.718 .473 SDS scores 59.18 ± 5.62 59.36 ± 6.01 0.252 .801 At 1-y follow-up SAS scores 48.37 ± 8.08 45.29 ± 8.35 3.063 .002 SDS scores 53.39 ± 6.17 51.34 ± 5.96 2.756 .006 Open in a new tab Abbreviations: PCI, percutaneous coronary intervention; SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale. Major Adverse Cardiovascular Event Incidence Rates There were no statistically significant differences between the groups in the incidence of MI and heart failure (Table 8 ). However, the incidence of cardiogenic shock was significantly lower in the nurse-led care group compared with the usual care group ( P = .032). The overall incidence rate of major adverse cardiovascular events was significantly reduced in the nurse-led care group (4.65%) compared with the usual care group (14.49%; P = .007). These findings show that nurse-led cardiovascular risk management improved outcomes by reducing major adverse events over 1 year. TABLE 8. Comparison of Major Adverse Cardiovascular Event Incidence Rates Between the 2 Groups Variable Usual Care Group (n = 138) Nurse-Led Care Group (n = 129) χ 2 P Myocardial infarction 4 (2.9%) 2 (1.55%) 0.109 .742 Cardiogenic shock 9 (6.52%) 1 (0.78%) 4.617 .032 Heart failure 7 (5.07%) 3 (2.33%) 0.738 .390 Total incidence rate 20 (14.49%)/118 (85.51%) 6 (4.65%)/123 (95.35%) 7.347 .007 Open in a new tab Discussion Cardiovascular disease is a major concern for patients with CKD on hemodialysis, especially after PCI. 3 , 4 The high prevalence of traditional and CKD-specific risk factors in this population makes effective risk management crucial. 5 The aim of this study was to investigate the impact of a nurse-led cardiovascular risk program on 1-year outcomes in patients on hemodialysis post PCI. The success of the nurse-led intervention can be attributed to its comprehensive approach, which organically integrates cardiovascular risk assessment with customized management plans. 5 – 7 These findings are consistent with the understanding from previous studies that individualized care can better meet the complex needs of patients with multiple comorbidities, such as CKD and cardiovascular disease. 16 – 18 This personalized approach is essential for the hemodialysis post-PCI population, which faces heightened cardiovascular risks due to multiple factors including CKD and postprocedural vulnerability. 12 , 13 , 29 – 31 The stratification of care intensities based on cardiovascular risk further suggests that individualized management appropriately aligns resources and interventions with patient needs, thus enhancing adherence and outcomes. 32 Nurse-led interventions were more effective than routine care in managing modifiable cardiovascular risk factors through continuous guidance. In addition, nurse-led education boosts patient understanding and engagement, equipping them with the knowledge to make informed decisions. Consequently, risk factor modification is not merely episodic but becomes a sustainable lifestyle change. 33 Renal function indicators improved in the nurse-led care group, as evidenced by significant reductions in SCR, UA, and phosphorus levels. Previous research has demonstrated the bidirectional relationship between cardiovascular and renal health in patients with CKD. 5 , 8 – 11 The interplay between cardiovascular and renal systems is well documented, and the program’s focus on mitigating cardiovascular risks could inadvertently support renal function. 34 , 35 Moreover, the improvement in vitamin D levels and PTH regulation suggests effective lifestyle and dietary modifications that might contribute to better renal and overall metabolic health in this cohort. The noted improvements in cardiac function indicators, particularly lipid profiles, underscore the nurse-led program’s role in instituting effective cardiovascular preventive measures. The significant reductions in total cholesterol and low-density lipoprotein levels might be attributed to stringent adherence to dietary guidelines and potentially better compliance with lipid-lowering therapies facilitated by frequent nurse-patient interactions. 36 , 37 The marked reductions in anxiety and depression scores in the nurse-led care group highlight the psychological and emotional support embedded in the intervention. The program’s structure emphasizes the importance of psychological counseling, understanding patient concerns, and providing empathetic care. By alleviating psychological burdens, such nursing care may indirectly bolster physiological resilience and treatment adherence. 38 , 39 The Short Form 36 Health Survey Questionnaire scores signify how targeted risk management transcends physical health, significantly impacting patients’ perceptions of their capabilities and their social interactions. The structured communication and continuous support inherent in the nurse-led program are crucial in fostering a supportive environment conducive to healing and rehabilitation, thereby elevating patients’ overall quality of life. 40 The reduction in the incidence of major adverse cardiovascular events, particularly cardiogenic shock, suggests a significant protective effect conferred by the nurse-led program. Mechanistically, effective risk factor control—reflected in better lipid profiles, renal function, and psychological health—might confer robustness against acute cardiovascular decompensation. 41 , 42 Moreover, increased health literacy and emergency preparedness equip patients with critical skills to respond effectively to emergent cardiovascular events, possibly mitigating their impact. 43 Although the study has achieved certain results, there are still some limitations. First, as a retrospective study, there may be potential bias. Second, the quantitative relationship and potential mechanism between nursing intervention and blood index changes have not been deeply explored. Third, in this study, we only performed static comparisons between the 2 groups without analyzing the dynamic changes of various indicators over time. In addition, the exact number of patients who benefited from the individualized nurse-led care was not reported, which limits the precise assessment of the intervention’s effectiveness. Future research should address these issues. Efforts should be made to enhance research design transparency and reproducibility, explore the relationship and mechanisms between interventions and blood index changes, analyze dynamic indicator fluctuations, and establish comprehensive criteria to accurately count the number of benefited patients. For instance, authors of future studies could define a patient as benefited when meeting multiple criteria, including a significant reduction in cardiovascular risk, improvement in at least 2 renal function indicators, normalized psychological scores, a notable increase in quality of life scores, and no occurrence of major adverse cardiovascular events. This would enable a more thorough evaluation of the personalized nursing care plan’s effectiveness. In conclusion, our study showed that nurse-led cardiovascular risk assessment and management could improve 1-year health outcomes for hemodialysis patients with CKD post PCI. The personalized care model offers a new approach for optimizing nursing practices. Future research should explore its feasibility in different settings, considering resource and training needs. The following are key recommendations for cardiovascular nurses: implement risk-based care plans, conduct regular follow-ups and education, provide diverse health training, monitor patient psychology, and collaborate closely with multidisciplinary teams. Footnotes Published online 7 July 2025 Wanting Zhao and Weiqiu Zhao are co-first authors. Ethics Statement: The study was approved by the Ethics Committee of Capital Medical University Affiliated Beijing Rehabilitation Hospital (2021-BJ-618). Author Contributions: W.T.Z. was involved in the conception and design, or analysis and interpretation of the data. 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