Multidisciplinary Approaches to Cardiac Risk Management Synergy between Nurses, ECG Technicians, and Pharmacists

Authors

  • Adel Sulaiman Aldhuwaila
  • Abdullatif Sulobi Alharbi
  • Sama Saad Alsulihem
  • Eman Salem AL Bishi
  • Maha Eshaiwi alenazi
  • Abdulelah Mudhhi Alanazi
  • Amal Saleem Almutairi
  • Faisal Abbad Alotaibi

Keywords:

Cardiovascular diseases, cardiac risk management, multidisciplinary approach, nurses, ECG technicians, pharmacists, patient care, medication adherence, early diagnosis, collaboration

Abstract

The CVDs are the most common cause of death globally and cause strain on the healthcare system Respiratory CVDs complicate the healthcare system due to rising risks factors in the population such as hypertension and diabetes. Effective management of cardiac and related diseases is needed. This explains the importance of multidisciplinary care involving nursing, ECG techs and pharmacists. Nursing, as education and monitoring of patients, leads in lifestyle changes, control of the symptoms, and adherence to effective medications. ECG Techs also play an important role in diagnosing and detecting cardiac conditions that are potentially very invasive. Ischemia and other arrhythmias are detected by ECG testing, allowing intervention. While pharmacists also play an important role in medication management by monitoring, optimizing adherence, and detecting potential interactions. Providing multidisciplinary care has been shown to improve outcomes. Communication challenges, role overlaps, and resource gaps have been shown to impact effective multidisciplinary care. Addressing these barriers has been shown to improve communication, training gaps, and healthcare team integration. This is a review of the role multidisciplinary care contributes and the importance of the integration for the provision of nursing care and ECG tech/pharmacist care. Systemic challenges can be overcome through collaboration in healthcare systems to improve CVD management and reduce the burden they cause globally

Downloads

Download data is not yet available.

References

1. Bhat R, Shanbhag P. Knowledge, Attitude, and Practice Study on Cardiovascular Disease Risk Factors in the Mangalore Community. Oral Sphere J. Dent. Health Sci. 2025;1(1):19-28.

2. Sharick Shamsi, Shabana khan, Comparative Study of Breathing Techniques After Coronary Artery By Pass Grafting, International journal of medical science and clinical Invention,2014;1:6:333-338.

3. Batchelor WB, Anwaruddin S, Wang DD, Perpetua EM, Krishnaswami A, Velagapudi P, Wyman JF, Fullerton D, Keegan P, Phillips A, Ross L, Maini B, Bernacki G, Panjrath GS, Lee J, Geske JB, Welt F, Thakker PD, Deswal A, Park K, Mack MJ, Leon M, Lewis S, Holmes D. The Multidisciplinary Heart Team in Cardiovascular Medicine: Current Role and Future Challenges. JACC Adv. 2023 Jan 11;2(1):100160. doi: 10.1016/j.jacadv.2022.100160. PMID: 38939019; PMCID: PMC11198656.

4. Yogesh MJ, Karthikeyan J. Health Informatics: Engaging Modern Healthcare Units: A Brief Overview. Front Public Health. 2022 Apr 29;10:854688. doi: 10.3389/fpubh.2022.854688. PMID: 35570921; PMCID: PMC9099090.

5. Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018 May;34(5):575-584. doi: 10.1016/j.cjca.2017.12.005. Epub 2017 Dec 11. PMID: 29459239; PMCID: PMC5953551.

6. Aagaard M, Stage AK, Boje Møller T, Pedersen SB, Pedersen CG. Exploring Hospital Healthcare Providers' Approaches to Multidisciplinary Initiatives and Complex Care Collaboration: A Qualitative Study. J Multidiscip Healthc. 2025 Apr 30;18:2401-2416. doi: 10.2147/JMDH.S513370. PMID: 40321886; PMCID: PMC12050017.

7. Riley J. The Key Roles for the Nurse in Acute Heart Failure Management. Card Fail Rev. 2015 Oct;1(2):123-127. doi: 10.15420/cfr.2015.1.2.123. PMID: 28785445; PMCID: PMC5490951.

8. Babaei S, Taleghani F, Farzi S. Components of Compassionate Care in Nurses Working in the Cardiac Wards: A Descriptive Qualitative Study. J Caring Sci. 2022 Aug 31;11(4):239-245. doi: 10.34172/jcs.2022.24. PMID: 36483686; PMCID: PMC9720497.

9. Khani S, Rafiei S, Ghashghaee A, Masoumi M, Rezaee S, Kheradkhah G, Abdollahi B. Cardiovascular risk factors among nurses: A global systematic review and meta-analysis. PLoS One. 2024 Mar 21;19(3):e0286245. doi: 10.1371/journal.pone.0286245. PMID: 38512844; PMCID: PMC10956831.

10. Stanulewicz N, Knox E, Narayanasamy M, Shivji N, Khunti K, Blake H. Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review. Int J Environ Res Public Health. 2019 Dec 18;17(1):17. doi: 10.3390/ijerph17010017. PMID: 31861367; PMCID: PMC6981404.

11. Mattioli AV, Gallina S. Early cardiovascular prevention: the crucial role of nurse-led intervention. BMC Nurs. 2023 Oct 2;22(1):347. doi: 10.1186/s12912-023-01511-6. PMID: 37784056; PMCID: PMC10546686.

12. Babaei S, Taleghani F, Kayvanara M. Compassionate behaviours of clinical nurses in Iran: an ethnographic study. Int Nurs Rev. 2016 Sep;63(3):388-94. doi: 10.1111/inr.12296. Epub 2016 Jun 16. PMID: 27312244.

13. Shakya, B., Upadhyay, S., Arshad, M. S., & Shadab. (2025). Insight into ECG: the crucial contribution of ECG technicians in cardiological monitoring and diagnosis. International Journal of Research in Medical Sciences, 13(7), 3117–3122. https://doi.org/10.18203/2320-6012.ijrms20252058

14. Sattar Y, Chhabra L. Electrocardiogram. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549803/

15. Cook DA, Oh SY, Pusic MV. Accuracy of Physicians' Electrocardiogram Interpretations: A Systematic Review and Meta-analysis. JAMA Intern Med. 2020 Nov 1;180(11):1461-1471. doi: 10.1001/jamainternmed.2020.3989. PMID: 32986084; PMCID: PMC7522782.

16. Shahjehan RD, Sharma S, Bhutta BS. Coronary Artery Disease. [Updated 2024 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564304/

17. Sandhoff BG, Kuca S, Rasmussen J, Merenich JA. Collaborative cardiac care service: a multidisciplinary approach to caring for patients with coronary artery disease. Perm J. 2008 Summer;12(3):4-11. doi: 10.7812/TPP/08-007. PMID: 21331203; PMCID: PMC3037123.

18. Omboni S, Caserini M. Effectiveness of pharmacist's intervention in the management of cardiovascular diseases. Open Heart. 2018 Jan 3;5(1):e000687. doi: 10.1136/openhrt-2017-000687. PMID: 29344376; PMCID: PMC5761304.

19. Ravi P, Pfaff K, Ralph J, Cruz E, Bellaire M, Fontanin G. Nurse-pharmacist collaborations for promoting medication safety among community-dwelling adults: A scoping review. Int J Nurs Stud Adv. 2022 Apr 18;4:100079. doi: 10.1016/j.ijnsa.2022.100079. PMID: 38745597; PMCID: PMC11080473.

20. Alshehri AA, Jalal Z, Cheema E, Haque MS, Jenkins D, Yahyouche A. Impact of the pharmacist-led intervention on the control of medical cardiovascular risk factors for the primary prevention of cardiovascular disease in general practice: A systematic review and meta-analysis of randomised controlled trials. Br J Clin Pharmacol. 2020 Jan;86(1):29-38. doi: 10.1111/bcp.14164. Epub 2020 Jan 3. PMID: 31777082; PMCID: PMC6983518.

21. Alkhawajah AM, Eferakeya AE. The role of pharmacists in patients' education on medication. Public Health. 1992 May;106(3):231-7. doi: 10.1016/s0033-3506(05)80541-4. PMID: 1603927.

22. Waszyk-Nowaczyk M, Guzenda W, Dragun P, Olsztyńska L, Liwarska J, Michalak M, Ferlak J, Drozd M, Sobiechowska R. Interdisciplinary Cooperation between Pharmacists and Nurses-Experiences and Expectations. Int J Environ Res Public Health. 2022 Sep 16;19(18):11713. doi: 10.3390/ijerph191811713. PMID: 36141986; PMCID: PMC9517073.

23. Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2018 Jul 19;7(7):CD006732. doi: 10.1002/14651858.CD006732.pub4. PMID: 30025154; PMCID: PMC6513543.

24. Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D, Pronovost PJ, Weaver SJ. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. Am Psychol. 2018 May-Jun;73(4):433-450. doi: 10.1037/amp0000298. PMID: 29792459; PMCID: PMC6361117.

25. Rahayu SA, Widianto S, Defi IR, Abdulah R. Role of Pharmacists in the Interprofessional Care Team for Patients with Chronic Diseases. J Multidiscip Healthc. 2021 Jul 5;14:1701-1710. doi: 10.2147/JMDH.S309938. PMID: 34267522; PMCID: PMC8275864.

26. Dyakova M, Shantikumar S, Colquitt JL, Drew CM, Sime M, MacIver J, Wright N, Clarke A, Rees K. Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2016 Jan 29;2016(1):CD010411. doi: 10.1002/14651858.CD010411.pub2. PMID: 26824223; PMCID: PMC6494380.

27. Thakkar R. Integrated working in cardiovascular care. Br J Cardiol. 2024 Sep 6;31(3):039. doi: 10.5837/bjc.2024.039. PMID: 39917556; PMCID: PMC11795915.

28. Netala VR, Teertam SK, Li H, Zhang Z. A Comprehensive Review of Cardiovascular Disease Management: Cardiac Biomarkers, Imaging Modalities, Pharmacotherapy, Surgical Interventions, and Herbal Remedies. Cells. 2024 Sep 1;13(17):1471. doi: 10.3390/cells13171471. PMID: 39273041; PMCID: PMC11394358.

29. Considine J. The role of nurses in preventing adverse events related to respiratory dysfunction: literature review. J Adv Nurs. 2005 Mar;49(6):624-33. doi: 10.1111/j.1365-2648.2004.03337.x. PMID: 15737223.

30. Considine J, Botti M. Who, when and where? Identification of patients at risk of an in-hospital adverse event: implications for nursing practice. Int J Nurs Pract. 2004 Feb;10(1):21-31. doi: 10.1111/j.1440-172x.2003.00452.x. PMID: 14764019.

31. Zeitoun SS, de Barros AL, Michel JL, de Bettencourt AR. Clinical validation of the signs and symptoms and the nature of the respiratory nursing diagnoses in patients under invasive mechanical ventilation. J Clin Nurs. 2007 Aug;16(8):1417-26. doi: 10.1111/j.1365-2702.2006.01632.x. Epub 2007 Apr 24. PMID: 17459131.

32. Pascoal LM, Lopes MV, Chaves DB, Beltrão BA, da Silva VM, Monteiro FP. Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection. Rev Lat Am Enfermagem. 2015 May-Jun;23(3):491-9. doi: 10.1590/0104-1169.0269.2581. Epub 2015 Jul 3. PMID: 26155010; PMCID: PMC4547073.

33. Birnbaum Y, Nikus K, Kligfield P, Fiol M, Barrabés JA, Sionis A, Pahlm O, Niebla JG, de Luna AB. The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document. Ann Noninvasive Electrocardiol. 2014 Sep;19(5):412-25. doi: 10.1111/anec.12196. PMID: 25262661; PMCID: PMC6932613.

34. Birnbaum Y, Rankinen J, Jneid H, Atar D, Nikus K. The Role of ECG in the Diagnosis and Risk Stratification of Acute Coronary Syndromes: an Old but Indispensable Tool. Curr Cardiol Rep. 2022 Feb;24(2):109-118. doi: 10.1007/s11886-021-01628-7. Epub 2022 Jan 13. PMID: 35028816.

35. Nikus KC, Eskola MJ. Electrocardiogram patterns in acute left main coronary artery occlusion. J Electrocardiol. 2008 Nov-Dec;41(6):626-9. doi: 10.1016/j.jelectrocard.2008.06.020. Epub 2008 Sep 13. PMID: 18790498.

36. Zhan ZQ, Wang W, Dang SY, Wang CQ, Wang JF, Cao Z. Electrocardiographic characteristics in angiographically documented occlusion of the dominant left circumflex artery with acute inferior myocardial infarction: limitations of ST elevation III/II ratio and ST deviation in lateral limb leads. J Electrocardiol. 2009 Sep-Oct;42(5):432-9. doi: 10.1016/j.jelectrocard.2009.03.015. Epub 2009 May 15. PMID: 19446838.

37. Abdulrhim S, Sankaralingam S, Ibrahim MIM, Awaisu A. The impact of pharmacist care on diabetes outcomes in primary care settings: An umbrella review of published systematic reviews. Prim Care Diabetes. 2020 Oct;14(5):393-400. doi: 10.1016/j.pcd.2019.12.007. Epub 2020 Jan 8. PMID: 31926868.

38. Jokanovic N, Tan EC, Sudhakaran S, Kirkpatrick CM, Dooley MJ, Ryan-Atwood TE, Bell JS. Pharmacist-led medication review in community settings: An overview of systematic reviews. Res Social Adm Pharm. 2017 Jul-Aug;13(4):661-685. doi: 10.1016/j.sapharm.2016.08.005. Epub 2016 Aug 28. PMID: 27665364.

39. Shrestha S, Iqbal A, Teoh SL, Khanal S, Gan SH, Lee SWH, Paudyal V. Impact of pharmacist-delivered interventions on pain-related outcomes: An umbrella review of systematic reviews and meta-analyses. Res Social Adm Pharm. 2024 Jun;20(6):34-51. doi: 10.1016/j.sapharm.2024.03.005. Epub 2024 Mar 13. PMID: 38514293.

40. Ali T, Siddiqui A, Bhutta OA, Mazhar S, Usman A, Raza I, Pathak N, Shrestha S. Improving Clinical Pharmacist Performance in Oncology Care Through Education on Pharmaceutical Care Plans Documentation: A Pre-post Interventional Study. Inquiry. 2025 Jan-Dec;62:469580251335819. doi: 10.1177/00469580251335819. Epub 2025 May 14. PMID: 40366352; PMCID: PMC12078956.

41. Fraser, Meg et al. Heart & Lung: The Journal of Cardiopulmonary and Acute Care, Volume 64, e1 - e16

42. Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014 Nov 20;2014(11):CD000011. doi: 10.1002/14651858.CD000011.pub4. PMID: 25412402; PMCID: PMC7263418.

43. Chatterjee A, Prinz A, Riegler MA, Das J. A systematic review and knowledge mapping on ICT-based remote and automatic COVID-19 patient monitoring and care. BMC Health Serv Res. 2023 Sep 30;23(1):1047. doi: 10.1186/s12913-023-10047-z. PMID: 37777722; PMCID: PMC10543863.

44. Yang H, Ma Q, Han L and Liu H (2025) A global prediction of cardiovascular disease from 2020 to 2030. Front. Cardiovasc. Med. 12:1462705. doi: 10.3389/fcvm.2025.1462705

45. Institute of Medicine (US) Committee on Preventing the Global Epidemic of Cardiovascular Disease: Meeting the Challenges in Developing Countries; Fuster V, Kelly BB, editors. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington (DC): National Academies Press (US); 2010. 2, Epidemiology of Cardiovascular Disease. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45688/

46. Levine JH. Managing multiple cardiovascular risk factors: state of the science. J Clin Hypertens (Greenwich). 2006 Oct;8(10 Suppl 3):12-22. doi: 10.1111/j.1524-6175.2006.05924.x. PMID: 17028479; PMCID: PMC8109623.

47. Ahmed L. Alkhaqani, (2023), Nursing Assessment of Cardiovascular System: Importance of History Taking and Physical Examination, Cardiology Research and Reports. 5(1); DOI:10.31579/2692-9759/089

48. Shan Y, Chen J, Zhou S, Wen G. Nursing Interventions and Care Strategies for Patients with Coronary Heart Disease: A Comprehensive Review. Galen Med J. 2023 Aug 19;12:e2994. doi: 10.31661/gmj.v12i0.2994. PMID: 38774841; PMCID: PMC11108677.

49. Norouzinia R, Aghabarari M, Shiri M, Karimi M, Samami E. Communication Barriers Perceived by Nurses and Patients. Glob J Health Sci. 2015 Sep 28;8(6):65-74. doi: 10.5539/gjhs.v8n6p65. PMID: 26755475; PMCID: PMC4954910.

50. Anoosheh M, Zarkhah S, Faghihzadeh S, Vaismoradi M. Nurse-patient communication barriers in Iranian nursing. Int Nurs Rev. 2009 Jun;56(2):243-9. doi: 10.1111/j.1466-7657.2008.00697.x. PMID: 19646175.

51. Gregory P, Kilner T, Lodge S, Paget S. Accuracy of ECG chest electrode placements by paramedics: an observational study. Br Paramed J. 2021 May 1;6(1):8-14. doi: 10.29045/14784726.2021.6.6.1.8. PMID: 34335095; PMCID: PMC8312365.

52. Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A, Cantillon DJ, Dilaveris P, Dubner SJ, El-Sherif N, Krol J, Kurpesa M, La Rovere MT, Lobodzinski SS, Locati ET, Mittal S, Olshansky B, Piotrowicz E, Saxon L, Stone PH, Tereshchenko L, Turakhia MP, Turitto G, Wimmer NJ, Verrier RL, Zareba W, Piotrowicz R. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Ann Noninvasive Electrocardiol. 2017 May;22(3):e12447. doi: 10.1111/anec.12447. PMID: 28480632; PMCID: PMC6931745.

53. BR P, R Y, Kumar P, Patil K, Chandavarkar V, Sagarkar AR. Diabetes and Dental Woes: A Study on Burden of Oral Diseases in Type 2 Diabetes Mellitus Patients in Mysuru. Oral Sphere J. Dent. Health Sci. 2025;1(2):48-55. doi: 10.63150/osjdhs.2025.1

54. Tariq RA, Vashisht R, Sinha A, et al. Medication Dispensing Errors and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519065/

55. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011 May;26(3):155-9. doi: 10.5001/omj.2011.38. PMID: 22043406; PMCID: PMC3191684.

56. Tan R, Kawaja A, Ooi SP, Ng CJ. Communication barriers faced by pharmacists when managing patients with hypertension in a primary care team: a qualitative study. BMC Prim Care. 2024 Mar 27;25(1):100. doi: 10.1186/s12875-024-02349-w. PMID: 38539081; PMCID: PMC10967190.

57. Sguanci M, Mancin S, Carù V, Simonelli N, Cangelosi G, Morales Palomares S, Ferrara G, Lo Cascio A. Exploring the Role of Advanced Practice Nurses in Cardiology: A Scoping Review. Int Nurs Rev. 2025 Sep;72(3):e70054. doi: 10.1111/inr.70054. PMID: 40583114; PMCID: PMC12206687.

58. Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich). 2012 Jan;14(1):51-65. doi: 10.1111/j.1751-7176.2011.00542.x. Epub 2011 Nov 28. PMID: 22235824; PMCID: PMC3257828.

Downloads

Published

2025-12-26

How to Cite

1.
Aldhuwaila AS, Sulobi Alharbi A, Saad Alsulihem S, Salem AL Bishi E, Eshaiwi alenazi M, Mudhhi Alanazi A, et al. Multidisciplinary Approaches to Cardiac Risk Management Synergy between Nurses, ECG Technicians, and Pharmacists. J Neonatal Surg [Internet]. 2025 Dec. 26 [cited 2026 Apr. 14];14(32S):10109-1. Available from: https://jneonatalsurg.com/index.php/jns/article/view/9769