Feasibility and early outcomes of a specialist nurse-led preventive cardiology pathway, integrating advanced risk assessment, lifestyle intervention, and community referral

Abstract Background Implementation of structured cardiovascular prevention remains inconsistent despite clear international guidance. A Preventive Cardiology Nurse Specialist (PCNS)-led service was developed to integrate advanced risk assessment, personalised lifestyle intervention, and community referral within routine cardiology care. Purpose To evaluate the feasibility and early outcomes of a newly established PCNS-led preventive cardiology service incorporating advanced diagnostics, lifestyle intervention, and community referral. Methods Adults referred from cardiology or general practice for cardiovascular risk assessment or secondary prevention optimisation were enrolled prospectively. Baseline assessment included lipid profile, lipoprotein(a), HbA1c, clinic blood pressure (24-h ABPM if indicated), QRISK3 (if statin-naïve), and DEXA body composition. Cardiovascular history, metabolic risk, and lifestyle factors (smoking, alcohol, physical activity, diet, sleep, stress, mental health) were recorded. All participants received a six-week email-based lifestyle programme. Community referrals included supervised exercise, cardiac rehabilitation, smoking cessation, and alcohol services. Follow-up occurred at 3–6 months and 12 months; only participants who had reached these timepoints were included. A 24-month review will be offered for elevated Lp(a) or persistent risk. Outcomes included changes in lifestyle behaviours and clinical markers (non-HDL-cholesterol, blood pressure, HbA1c, weight). Analyses were descriptive. Results Sixty-six patients were enrolled (mean age 59 years; 46% female). At 3–6 months, 89% reported increased activity, 89% improved diet, and 76% better sleep. Of 14 smokers, 71% reduced or quit (−11 cigarettes/day), and 85% of drinkers reduced alcohol intake. Mean clinical changes were: weight −2.7 kg (n=29), systolic BP −5 mmHg (n=27), HbA1c −0.11% (n=31), and non-HDL-cholesterol −0.23 mmol/L (n=37). At 12 months, improvements persisted: activity (91%), diet (100%), sleep (83%). All smokers (n=5) quit or further reduced (−14/day), and alcohol intake decreased in 89%. Mean changes were: weight −5.7 kg (n=19), systolic BP −5 mmHg (n=18), HbA1c −0.23% (n=20), and non-HDL-cholesterol −0.68 mmol/L (n=22). Lp(a) was measured in 95%; 33% were 75 nmol/L. DEXA was performed in 88%; of these, 55% had elevated visceral adipose tissue (VAT 100 cm²), 22% were normal, and 22% awaited VAT analysis. Referrals were made to supervised exercise (56%), smoking cessation (61% of smokers), and cardiac rehabilitation (8%). Conclusions A PCNS-led preventive cardiology pathway is feasible and acceptable, with early and sustained improvements in lifestyle behaviours and cardiometabolic risk factors. This real-world model may help bridge the gap between guideline recommendations and service delivery. Longer-term follow-up and larger studies are required to confirm sustainability and cost-effectiveness.For image description, please refer to the figure legend and surrounding text.