Subject(s)
Cardiology/standards , Clinical Competence/standards , Competency-Based Education/standards , Nurse Practitioners/standards , Physician Assistants/standards , Research Report/standards , Adult , Cardiology/education , Cardiology/methods , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Competency-Based Education/methods , Humans , Nurse Practitioners/education , Physician Assistants/education , United StatesSubject(s)
Cardiology/education , Echocardiography/standards , Education, Medical, Continuing , Education, Medical, Graduate , Clinical Competence , Consensus , Curriculum , Educational Measurement/standards , Fellowships and Scholarships , Humans , Societies, Medical , Specialty Boards , United StatesABSTRACT
BACKGROUND: Atherosclerotic cardiovascular disease is the foremost cause of death for U.S. adults. The 2013 ACC/AHA Adult Cholesterol Guidelines recommend high-intensity dose statins for individuals with coronary artery disease (CAD). OBJECTIVE: To determine healthcare provider compliance with the Cholesterol Guideline recommendation specific to high-intensity dose statins for patients with CAD. METHODS: A retrospective chart review was conducted to determine compliance rate. A questionnaire was developed to evaluate healthcare provider beliefs, attitudes, and self-confidence toward this recommendation. RESULTS: Of the 473 patients with CAD, 67% were prescribed a high-intensity dose statin. Patients with non-ST segment myocardial infarction and ST segment myocardial infarction were more likely to be prescribed a high-intensity dose statin versus a moderate or low-intensity dose. Healthcare providers strongly agreed with this guideline recommendation. CONCLUSION: There exists a dichotomy between intention to prescribe and actual prescribing behaviors of high-intensity dose statin for patients with CAD.
Subject(s)
American Heart Association , Cholesterol/blood , Coronary Artery Disease/prevention & control , Guideline Adherence , Health Personnel/standards , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Patient Compliance , Adult , Aged , Coronary Artery Disease/complications , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Retrospective Studies , United States , Young AdultABSTRACT
OBJECTIVES: We conducted a demonstration project to assess the value of a nurse practitioner (NP) based coronary artery disease management (CAD-DM) program for patients with an acute coronary syndrome (ACS) or percutaneous coronary intervention. METHODS: Patients were recruited to attend three 1-h monthly visits. The intervention included assessment of clinical symptoms and guideline-based treatments; education regarding CAD/ACS; review of nutrition, exercise, and appropriate referrals; and recognition of significant symptoms and emergency response. RESULTS: Two hundred thirteen (84.5%) completed the program. Physician approval for patient participation was 99%. Average age was 63 ± 11 years, 70% were male, and 89% white. At baseline, 61% (n = 133) had one or more cardiopulmonary symptoms, which declined to 30% at 12 weeks, p < .001. Sixty-nine percent attended cardiac rehabilitation or an exercise consult. Compared to the initial assessment, an additional 20% were at low-density lipoprotein cholesterol < 70 mg/dL (p = .04), an additional 35% met exercise goals (p < .0001), and there was an improvement in the mental (baseline 49.7 vs. 12 weeks 53, p = .0015) and physical components (44 vs. 48, p = .002) of the SF-12 health survey. CONCLUSION: This NP-based CAD-DM program was well received and participants demonstrated improvement in physical and mental health, and increased compliance with recommended lifestyle changes.
Subject(s)
Coronary Artery Disease/rehabilitation , Nurse Practitioners , Patient Compliance , Patient Discharge , Practice Patterns, Nurses' , Benchmarking , Coronary Artery Disease/nursing , Coronary Artery Disease/psychology , Female , Humans , Male , Michigan , Middle Aged , Quality of LifeABSTRACT
Despite the paucity of evidence, it is often presumed, and is physiologically plausible, that sudden, acute elevations in blood pressure may transiently increase the risk of recurrent aortic dissection (AD) or rupture in patients with a prior AD, because a post-dissection aorta is almost invariably dilated and may thus experience greater associated wall stress as compared with a nondilated aorta. Few data are available regarding the specific types and intensities of exercise that may be both safe and beneficial for this escalating patient population. The purpose of this editorial/commentary is to further explore this conundrum for clinicians caring for and counseling AD survivors. Moderate-intensity cardiovascular activity may be cardioprotective in this patient cohort. It is likely that severe physical activity restrictions may reduce functional capacity and quality of life in post-AD patients and thus be harmful, underscoring the importance of further exploring the role of physical activity and/or structured exercise in this at-risk patient population.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Exercise , Motor Activity , Adult , Age Factors , Aged , Aortic Dissection/diagnosis , Aortic Dissection/mortality , Aortic Dissection/physiopathology , Aortic Aneurysm/diagnosis , Aortic Aneurysm/mortality , Aortic Aneurysm/physiopathology , Arterial Pressure , Female , Heart Rate , Humans , Life Style , Male , Middle Aged , Quality of Life , Recurrence , Risk Factors , Risk Reduction Behavior , Treatment OutcomeABSTRACT
Of the nearly 1.4 million hospitalizations for acute coronary syndromes in 2006, approximately two-thirds were for unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI). Given the high risk for in-hospital ischemic events and late mortality in patients with UA/NSTEMI, it is critical to accurately and rapidly diagnose these patients, stratify their level of risk, and provide appropriate pharmacologic and nonpharmacologic treatment that maximizes anti-ischemic benefit and minimizes risk of bleeding. Appropriate in-hospital care following intervention is critical for optimizing both short- and long-term outcomes. However, evidence suggests that up to 26% of opportunities to provide guidelines-recommended care are missed. Nurses can play a critical role in ensuring that patients receive guidelines-based care. This review examines the most recent recommendations for the diagnosis and pharmacologic management of patients with UA/NSTEMI and discusses ways in which nursing staff can contribute to minimizing patient risk and optimizing patient benefit.
Subject(s)
Acute Coronary Syndrome/nursing , Treatment Outcome , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/physiopathology , Electrocardiography , Humans , Practice Guidelines as Topic , TriageSubject(s)
Myocardial Ischemia/diagnosis , Myocardial Ischemia/therapy , Angina, Unstable/diagnosis , Angina, Unstable/therapy , Biomarkers/metabolism , Critical Care/methods , Critical Care/standards , Electrocardiography/methods , Emergency Nursing/methods , Fibrinolytic Agents/therapeutic use , Guideline Adherence , Humans , Medical History Taking/methods , Myocardial Infarction/diagnosis , Myocardial Infarction/metabolism , Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Myocardial Ischemia/metabolism , Myocardial Ischemia/physiopathology , Physical Examination/methods , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Practice Guidelines as Topic , Risk Assessment/methods , SyndromeABSTRACT
The American Heart Association has been the recognized source for Advanced Cardiac Life Support (ACLS) education for the past three decades. Since the first ACLS course, numerous revisions have been made to the management algorithms based on evolving scientific evidence. The last revisions made in August 2000 were the first international guidelines published. These guidelines reflect the intense review and analysis of scientific work and emphasize the importance of evidence-based therapies. This article outlines the major changes to ACLS guidelines for dysrhythmias, acute coronary syndromes, and acute stroke management.
