Nurse Practitioner Waterloo Regional Health Network @Queens, Ontario, Canada
Background: Many global healthcare systems primarily focus on treating illness rather than preventing it. This reactive approach, centered on episodic care, often overlooks upstream opportunities to reduce the incidence of chronic diseases. Notably, approximately 80% of cardiovascular events are attributable to modifiable risk factors, and over 90% of chronic diseases are linked to four key behaviors: tobacco use, alcohol consumption, physical inactivity, and unhealthy eating. These behaviours are deeply influenced by the social determinants of health and require a multidisciplinary strategy for effective risk reduction.
Given the significant burden of cardiovascular disease locally in the Region of Waterloo, and across Ontario and Canada, a proactive, preventive approach is essential. Early intervention to optimize cardiovascular risk factors before the onset of symptomatic disease is critical to ensuring the sustainability of our publicly funded healthcare system and reducing the socioeconomic impact of chronic illness.
METHODS AND RESULTS: In response, the Waterloo Regional Health Network (WRHN), with support from Manulife Canada, established the PREVENT Clinic (Prevention Not Events), a primary prevention clinic for atherosclerotic cardiovascular disease (ASCVD). The clinic operates within the existing cardiac rehabilitation facility and offers services at no cost to patients with two or more cardiovascular risk factors. Patients receive a comprehensive cardiovascular risk assessment conducted by a nurse practitioner (NP), followed by coordinated care from a multidisciplinary team (MDT), which includes registered dietitians, kinesiologists for individualized exercise prescriptions, respiratory therapists for smoking cessation, and social workers.
Since its launch in Fall 2024, the PREVENT Clinic has served nearly 100 patients—41% of whom do not have a primary care provider. Referrals primarily come from family physicians and emergency departments. The clinic has achieved notable success, with over 90% of patients reaching target blood pressure levels, and over 88% achieving optimal lipid and glycemic control. Patients have expressed high satisfaction, particularly with the personalized lifestyle interventions and concurrent medical optimization provided by the NP.
Conclusion: The PREVENT Clinic represents a novel, NP-led model that leverages existing cardiac rehabilitation infrastructure to deliver accessible, multidisciplinary care focused on cardiovascular risk assessment, education, and medical management. This approach demonstrates the feasibility and effectiveness of integrating primary prevention into current healthcare frameworks to reduce the long-term burden of ASCVD.
