2012 Poster Presentation Winners
Nearly 30 poster presentations were submitted for the Preventive Cardiovascular Nurses Association's Annual Poster Session at the 18th Annual Symposium in Washington DC on April 12, 2012. There were 2 categories for poster presentations, including Data-Based Research, for presentation of original research findings, and Innovation in Patient Care, for presentation of creative projects/programs in patient care.
Listed below are the oral abstract presentation winners and the top 3 winners in each category. All remaining accepted abstracts will be published in the September/October issue of the Journal of Cardiovascular Nursing.
Category: Data-Based Research
First-Place Winner: Predictors of Health Related Quality of Life in Patients With Atrial Fibrillation/Atrial Flutter
Bimbola Akintade, PhD, ACNP-BC, MHA1, Deborah Chapa, PhD, ACNP-BC, The George Washington University, Washington, DC, Sue Ann Thomas, PhD, RN, Erika Friedmann, PhD, 1University of Maryland Baltimore, School of Nursing.
Background: Health related quality of life (HRQoL) in patients with atrial fibrillation (AF)/atrial flutter (AFL) is an important component of cardiovascular health management. Due to inadequate drug efficacy and adverse side effects, there is an increase in nonpharmacologic therapies in the management of AF/AFL. Determinants of HRQoL of patients with AF/AFL require further elucidation.
Objectives: To determine baseline predictors of health related quality of life (HRQoL) of patients with AF/AFL. To evaluate risk factors for patients with AF/AFL that will require additional evaluation and treatment efforts.
Methods: Atrial fibrillation/atrial flutter patients (n = 150) participated in a prospective multi-site hypothesis-generating quasi experimental study. Health related quality of life was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Severity Checklist. Linear regression modeling was then performed to determine predictive factors of HRQoL among variables including patients' age, gender, race, marital status, type of AF/AFL, frequency of symptoms, time since diagnosis, anxiety and depression symptoms, frequency of AF/AFL symptoms.
Results: In female patients, AF/AFL demonstrated a greater impact on self-reported physical HRQoL than male patients. Elevated self-reported symptoms of depression and anxiety were found to be associated with poorer HRQoL. Younger patients demonstrated an association with worse AF/AFL related symptom and severity than older patients. Increased frequency of symptomatic episodes demonstrated an association with worse AF/AFL related symptom and severity.
Conclusion: Elevated depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in patients with AF/AFL. These indicators should be considered risk factors in identifying patients who may require additional evaluation and treatment efforts to manage their cardiac conditions and other known risks. Mechanisms and treatment options also deserve further study.
Second-Place Winner: Global Risk Assessment in Resource Constrained Countries: Kenya Heart and Sole
Eileen M, Stuart-Shor, PhD, APN, FPCNA, FAHA, FAAN, Jacob K. Kariuki, RN, BSN, Joelle Chateauneuf, RN, MS, ANP, University of Massachusetts, Boston; Samuel Kimani, RN, MSc, BScN, Anna K. Karani, PhD, MA, BScN, DAN, RN/M/CHN, University of Nairobi, Nairobi, Kenya.
Background: Global risk assessment has become an important part of comprehensive CV evaluation and guides treatment. Most global risk tools require laboratory measurement of lipids, a test not readily available in resource-constrained countries. The Gaziano Risk Score (GRS) is a non-lab based model which includes age, gender, diabetes, smoking, systolic BP and substitutes BMI for cholesterol. In comparative effectiveness analysis the GRS has similar predictive value compared to the Framingham score.
Objectives: The purpose of this study was to add risk stratification using clinical estimations of the number of CV risk factors (CVRF) and the GRS to our community-based CV screenings.
Methods:Community based participatory research: a convenience sample of consecutive patients at 5 Kenyan clinics was screened for CVRF by trained US/Kenyan teams using protocols for physiologic and behavioral measures. Clinical data were abstracted, entered onto Excel spreadsheets and imported into Stata(C) for anaysis. US/Kenyan IRB approval was obtained.
Results: 801 individuals (mean age 54 [+/-17.5], 77% female, 98% black) were screened and found to have high rates of HTN (55.6%), DM (9.2%), and BMI >=25 (53.8%). The prevalence of smoking was 5.3%, CVD 3.61% and dyslipidemia 2.81%. The majority, (61.4%) had 2+ CVRF. The GRS (risk of developing CVD in the next 10 years); low risk (<10%), moderate risk (10-20%), and high risk (>20%) was (35.2%, 22.4%, and 42.4%) respectively. Clinician calculations of the GRS were 75% accurate.
Conclusions/Implications: In those individuals who presented for community CV screening the prevalence/clustering of risk factors was high. This has implications for practice and policy. At the individual level it identifies those at high risk for complications and targets therapy; at the population level it can help identify the mean risk in the population which can help guide appropriate policies for access, care delivery and cost in resource-constrained countries.
Third-Place Winner: Majority of Stressors Experienced by Heart Failure Patients Not Directly Related to Their Illness
Mary P. Schooler, APRN, PMHNP-BC1, Ann L. Peden, PhD, RN, Capital University, Columbus, Ohio; Misook L. Chung, PhD, RN, Debra K. Moser, DNSc, RN, FAAN, 1University of Kentucky, College of Nursing, Lexington.
Background: Depression and anxiety frequently occur among individuals with heart failure (HF) and are associated with poor outcomes. It is commonly believed that living with HF is the key stressor contributing to these potentially disabling mood disorders.
Purpose: The purpose of this qualitative, descriptive study was to determine if HF is indeed the most common stressor identified.
Method: We analyzed transcripts of in-session statements made by participants with HF who received a biofeedback-cognitive therapy intervention. The intervention was part of a randomized controlled trial whose aim was to improve physical and psychosocial outcomes in HF patients. The transcripts are notes of patient comments that had been recorded by the clinical interventionist while administering the intervention protocol. Patients were categorized into three groups based on the types of stressors experienced: HF-related stressor, non HF-related stressor, or a combination of both. Percentages were then calculated for each group.
Results: Of 60 participants (mean age 60 +/- 13 years, 40% women, 46% NYHA class III/IV, 47% married, mean ejection fraction 37% +/- 13), only three (5%) indicated HF was their only source of stress (e.g., activity limitations associated with HF). Thirty-three (55%) described stressors which were not related to their HF, such as relationship issues, chronic pain, grief, other health conditions, work-related stressors, finances, current events, and the general hassles of daily life (e.g., traffic). Twenty-four (40%) identified stressors that originated from both HF and non-HF related sources. Among those in the combination group, 12 (50%) referred to non-HF related stressors as their primary sources of distress.
Conclusion: HF patients predominately reported stressors that were non-HF related. As a means of improving outcomes, the findings suggest that it might be beneficial for the clinician to assess what sources of stress may be present other than those associated with HF itself.
Category: Innovation in Patient Care
First-Place Winner: Promoting Heart Health in Vulnerable Populations of Women
Natasha Prodan-Bhalla, BScN, MN, NP (A), CCN (C), Diane Middagh, BScN, MN, NP (F), Cheryl Davies, RN, MEd, Ann Pederson, MSc, Shabnam Ziabakhsh, BA, MA, PhD, BC, Women's Hospital and Health Centre, Vancouver, BC, Canada.
Background: Women who are most at risk of heart disease and stroke are those who live in poverty and suffer from mental health, trauma, and addictions issues. These women face social and structural barriers to accessing health care: poverty, social isolation, violence, caregiving burden and cultural and language barriers. In spite of these well documented realities, a large proportion of these women never access primary prevention activities and few programs have been tailored to meet the needs of this population.
Purpose: A primary health care approach has been shown to mitigate health inequities in marginalized populations. The Heart Demonstration Project was established to address the gaps in health promotion services experienced by women living in the inner-city and to develop a framework for providing health promotion and disease prevention strategies to this population.
Design/Implementation: Funding was provided by the Provincial Health Services Authority to develop a strategic framework for developing primary prevention strategies to vulnerable women at risk of developing heart disease. The Heart Health Demonstration Project was established at a community based primary care clinic. A needs assessment was conducted to understand barriers to health promotion activities and identify areas of greatest need. Based on this initial assessment, drop-in group medical appointments were implemented and adapted to meet the needs of women in the community.
Evaluation/Outcomes: A change in behaviour and knowledge will be assessed using pre and post questionnaires. Weekly evaluation of the topic covered will also be conducted.
Implications for Practice: Successful implementation of a heart health promotion program for vulnerable women requires in-depth planning, engagement of key stakeholders and collaboration with community partners as well as an understanding of the unique lived experiences of the prospective clients. The success of this project will decrease existing inequities among women who are at risk of heart disease.
Second-Place Winner: Anxiety, Depression, and Coping Strategies in Patients Presenting to a Women's Heart Health Clinic
Mary P. Nejedly, MS, NP-BC, Andrea S. Chambers, PhD, Katherine C. Sears, PhD, Sandra A. Tsai, MD, MPH, Jennifer Tremmel, MD, MS, Stanford University Medical Center, California.
Background: Anxiety and depression are common among women. In addition, both have been associated with the development of heart disease, as well as a worse prognosis after the diagnosis of heart disease. Still, little is known about the mental health issues and coping strategies of women seeking outpatient cardiac care.
Objective: To assess the prevalence of anxiety and depression in women presenting to a women's heart health clinic and to identify utilized coping strategies.
Research Design: Female patients were invited to complete a survey assessing mental health, coping strategies, and the interplay of mental health and heart health.
Results: From March to June 2011, 117 women completed the survey. Medium to high anxiety was found in 26% of the respondents, and 25% reported some level of depression. There were several coping mechanisms identified, including exercise (56%), social support (35%), religion (33%), eating (22%), and self-blame, denial, and substance use (17%). Use of negative coping strategies was significantly correlated with self-reported anxiety, depression, and stress symptoms (p < 0.001). Over a third felt their emotions and mood impacted their ability to follow heart-healthy recommendations. Women who had more difficulty adhering to medical recommendations had more risk factors for heart disease.
Conclusion: Women presenting to a women's heart health clinic report a substantial amount of anxiety and depression. Coping methods utilized are largely positive, but there is also a common use of negative coping strategies, such as eating. Negative coping strategies are correlated with symptoms of anxiety, depression, and stress, and this may impact a woman's ability to follow heart-healthy recommendations.
Implications for Practice: The results of this survey support the integration of behavioral health services into a women's heart health clinic. Such services could improve identification and treatment of anxiety and depression, as well as assist in promoting more positive coping strategies.
Third-Place Winner: It's a Walk Through the Heart You'll Never Forget
Kelly Galler, MSN, GNP, Bellin Health System, Green Bay, Wisconsin.
Purpose: A heart care leader provides low cost, high quality care, and makes a positive impression on consumers. This 21 x 17 foot, interactive, anatomically correct, walk through heart achieves just that. Visibility. This long lasting mental image of your heart, coupled with an educational tour, makes Bellin Heart and Vascular Center "Top of Mind" in our community. We show how much we care when we showcase our enormous heart. No one else in the nation is able to teach the community the way we can.
Implementation: The AmeriHeart was rented as a trial to evaluate the community's response to this innovative heart exhibit. RN staff gave tours and answered questions to over 700 children and adults. Tours included normal heart anatomy and visual examples of heart attack, bypass graft, endocarditis, septal wall defect, and mitral valve prolapse. The first 100 adults completed an evaluation upon exiting the heart.
Evaluation and Outcomes: Questions were directed at learning if the community liked the exhibit, if they learned something from it and if they thought it would be valuable to have this exhibit at other events. There was an overwhelmingly positive response.
Implication for Practice: The AmeriHeart is an interesting, exciting and attractive way to make an imprint about heart health on the community. We now own the AmeriHeart and take it to schools, health fairs, the local Heart Walk and other healthy events. In 6 months, over 4,100 people have experienced this exhibit and raved about their experience and interactions with cardiac staff. People are so amazed to understand better about their heart because of this visual tool. The AmeriHeart provides a new way to gain trust and respect with our consumers, so when they need heart care, Bellin Health is the organization they think of first.
2012 Preventive Cardiovascular Nurses Association Annual Symposium Oral Abstract Presentations
The Preventive Cardiovascular Nurses Association awarded the first or coauthors of an abstract in each category, Data-Based Research and Innovation in Patient Care, the opportunity to present their abstract at the PCNA Annual Symposium. The oral abstract presentations are listed below.
Category: Data-Based Research
Nurse LED Smoking Cessation as Part of a Preventive Cardiology Programme: The Euroaction Plus (EA+) RCT
Catriona S. Jennings, BA Hons RN, FESC, Kotseva D. Kornelia, J. Jones, A. Mead, D. Wood, Imperial College London, London, United Kingdom; Dirk P. De Bacquer, Ghent University, Ghent, Belgium; Arno P. Hoes, University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, the Netherlands; Jose P. De Velasco, University General Hospital of Valencia, Department of Cardiology, Valencia, Spain; S. Brusaferro, University Hospital "Santa Maria della Misericordia," Udine, Italy; S. Tonstad, Oslo University Hospital, Oslo, Norway.
Background and Objectives: This second EUROACTION trial investigated whether a nurse-led preventive cardiology programme for high CVD risk smokers, with intensive cessation support including optional varenicline, could achieve more effective smoking abstinence in addition to reducing overall CVD risk compared to usual care (UC).
Methods: EA+ was evaluated in 4 European countries using a RCT design. Smokers 18 to 80 years with vascular disease and 50-80 years at high risk of developing CVD (Heart score >=5% over 10 years, or treated for risk factors or DM) were randomised to EA+ or UC. The primary outcome was 7 day point prevalence of abstinence (7DPPA) validated by breath CO <10 ppm at 16 weeks. The secondary outcomes included the proportion of patients achieving the European dietary, physical activity, risk factor and therapeutic targets for CVD prevention and health related quality of life (HRQoL).
Results: 696 patients were recruited: 350 randomised to EA+ and 346 to UC. 85% EA+ and 83% UC returned at 16 weeks. The intention to treat (ITT) results are given below.
Conclusions: EA+ programme was successful at getting high CVD risk smokers to quit and improve their diet and physical activity together with BP control. EA+ patients gained a mean 1.6 kg in weight due to smoking cessation which may have impacted unfavourably on lipid management. Overall HRQoL was improved.
Category: Innovation in Patient Care
LIPID Screening for Cardiovascular Risk Assessment Increased Through Team-Based, Patient-Centered Strategies Supported by Informatics at Kaiser Permanente Colorado
Sally S. Foland, BSN, RN, MS, IA1, John A. Merenich, MD2, Alison Phillips, RN-BC, BSN, 1Kaiser Permanente, Denver, Colorado; Juanita Redfield, MD, 2Colorado Permanente Medical Group, Denver.
Background: At Kaiser Permanente Colorado (KPCO), adult members missing Framingham data for cardiovascular (CV) risk assessment were mostly missing lipid profiles. CV risk assessment leads to identification of high risk patients to target for evidence-based treatments for reducing risk of new major coronary events (MCE).
Purpose/Problem: In January 2010 the CV risk status of 37% of KPCO members was unknown. System-wide, patient-centered, technology-supported team strategies to ensure screening for CV risk assessment were needed.
Design/Implementation: A process improvement (PI) project identified changes to improve lipid screening and later spread in primary care. Promotion and use of non-fasting lipid testing removed patient barriers to completing the test. Guidelines empowered nursing staff to order cholesterol tests. EMR integrated informatics supported team members to view or know when data was missing for CV risk status and act on alerts for lipid orders when lipids weren't done in five years. Approval from primary care leaders to place lipid screening on the primary care and nursing dashboards elevated the importance of it and increased accountability.
Evaluation and Outcomes: As reflected in the data below, implementation of these changes resulted in a decrease in un-assessed members, an increased percent members age 40-80 with CV risk known and lipid screening, and an increased percent of completed lipids that were non-fasting:
Implications for Practice: Obtaining patient input and providing guidelines and informatics support lead to increased lipid screening for CV risk assessment. To achieve the Million Hearts campaign goals of reducing MCEs, population strategies such as these will need to be adopted.