President's Message
After a decade of experience and enthusiasm, the Preventive Cardiovascular Nurses Association (PCNA) continues its mission of promoting and supporting the role of nurses in the practice of cardiovascular risk reduction and disease management. As President, I am honored to serve this wonderful organization. Our current membership of 1600 healthcare professionals throughout the United States, Canada, South America, and Europe continues to expand and represent an ever-growing number of nurses in primary and secondary prevention.
The 10th Annual PCNA Symposium, entitled "New Horizons in Cardiovascular Risk Reduction," was recently held in Orlando, Fla, April 22-24, 2004, at Disney's Coronado Springs Resort. Approximately 500 attendees and 50 exhibitors listened to state-of-the-art lectures and workshops about hypertension, diabetes, exercise, acute coronary syndromes, angina, heart failure, lipids, sexual and women's health, and other topics such as genetics and the environment. Two preconference workshops-a "Review Course in Cardiac/Vascular Certification" for nurses and "Implementing a Weight Loss Program for High Risk Individuals"-were highly successful in offering attendees more in-depth training.
Our current state of healthcare demands that nurses play a much larger role in the identification and implementation of cardiovascular risk reduction strategies for adults and children. PCNA is dedicated to the continued education of nurses so that we may all rise to this challenge. The corporate support that we receive has a direct impact on our mutual goals of achieving better participation of patients in their healthcare, improved health outcomes, the creation of newer and better patient care systems, and a reduction of death and disability through the prevention of cardiovascular disease across the lifespan.
With the generous support of our sponsors, we have been able to provide scholarships to offset registration costs that have allowed some of our members to attend the national meeting. In addition, unrestricted educational grants made it possible for us to provide the highest quality meeting with world-renowned speakers. We are most appreciative of their continued support of our organization and specifically thank our Corporate Partners: AstraZeneca, CV Therapeutics, GlaxoSmithKline, Merck/Schering-Plough, and Pfizer; Corporate Members: Cholestech and Kos; Corporate Affiliates: General Mills Cheerios, Quaker Oats, and the Walnut Commission; and Annual Symposium Sponsors: American Diabetes Association, American Dietetic Association, and American Heart Association Councils on (1) Cardiovascular Nursing, (2) Nutrition, Physical Activity and Metabolism, and (3) Epidemiology and Prevention. Also sponsoring the Annual Symposium were: Abbott Laboratories, AstraZeneca, Bayer, Cholestech, Generals Mills Cheerios, Guidant Foundation, Kos, LipoScience, Merck/Schering-Plough, Masterfoods, Pfizer, and Reliant.
As an organization, one of our primary goals is to promote research in cardiovascular disease prevention. We are proud that over 30 PCNA members submitted abstracts and developed posters related to clinical research and patient education, patient management, and program structure. In addition, members who have dedicated much of their time and effort to ensure PCNA's success were honored at a Leadership Luncheon. Gayle Whitman spoke about "Leadership in the New Millennium," and left everyone with a sense of passion and continued renewal to move ahead to fulfill our mission.
While the national meeting is but one of our activities, each year it provides an opportunity for networking, fosters professional development, and highlights the field of preventive cardiovascular nursing as a rewarding career choice. It also offers a forum for learning how you can be involved at the local and regional level of PCNA. The "Tell a Friend" About Women and Heart Disease campaign highlighted in this issue is just one example of where we need everyone's help. Our goal is to affect the lives of over 5000 women in 2004 through our education efforts!
It is the dedication I see from all of you who serve PCNA that makes me proud to be part of this ever-growing organization. I thank all of you who are making a difference in the lives of others and look forward to working with you over the next year.
Sincerely,
Nancy Houston Miller
The "Tell a Friend" About Women and Heart Disease campaign
The "Tell a Friend" About Women and Heart Disease campaign was unveiled to attendees of PCNA's 10th Annual Symposium in Orlando, Fla, on Friday, April 23. This educational program is focused on raising awareness about women and heart disease, an important health issue as heart disease claims the lives of nearly 500,000 women per year.
PCNA's "Tell a Friend" About Women and Heart Disease campaign is an expansion of the project originally started by national organizations such as the National Heart, Lung, and Blood Institute, WomenHeart: The National Coalition for Women with Heart Disease, and the American Heart Association. PCNA nursing professionals are ideally suited to address women's cardiovascular health since women make up 95% of the nursing profession and can therefore identify well with the population targeted by this campaign. PCNA members have a significant personal as well as professional stake in this initiative.
Meeting attendees were asked to help raise awareness of and encourage the women in their communities to prevent heart disease. A set of slides for this campaign has been developed to aid in the facilitation of these community events. The slides contain information including statistics, risk factors, and measures that can be taken to help prevent heart disease. At the end of the program, attendees were asked to sign a pledge that they would pass this message on to at least 10 women in their community. There were 203 cards signed, pledging to pass the word on to over 4700 women!
To monitor our success, participants were asked to complete the feedback form on http://www.pcna.net. To date, five programs have been presented to a total of 381 women at events such as National Scrapbooking Day, the Italian Club, Women for Life Health Fair, Lunch and Learn at a regional healthcare conference, and an all-daughter banquet at a local church. Congratulations and thank-you to those who have already passed along this very important message.
To become involved in PCNA's "Tell a Friend" About Women and Heart Disease campaign, visit http://www.pcna.net to download a pledge card, the information page, and slide set. Please return to the PCNA website after your presentation to complete the feedback form. Thank-you for making a difference in the lives of the women in your community!
The 10th Annual PCNA Symposium and Exposition
The 10th Annual PCNA Symposium and Exposition in April 2004 was a tremendous success. Part of the energy that permeated the conference was the direct result of the stimulating and challenging presentations by our renowned speakers. The opening keynote session certainly set the stage. Following are brief summaries of just a few of these important presentations.
Keynote: The Challenge of Health Disparities: Cardiovascular Nurses as Prevention Champions
Dr George Mensah, Chief, Cardiovascular Health Branch of the CDC provided the opening challenge to PCNA members, namely to "Get Tough on Disparities." He eloquently demonstrated that eliminating health care disparities does have some success stories but that much work is still needed. Cardiovascular diseases alone account for one third of the disparities in healthy life-expectancy between black and white Americans. The evidence is compelling for disparities in the delivery of quality diagnostic and therapeutic interventions. But he explains that there is a major need to go beyond just improving "access to care," to including systematic improvements in coordination, management, quality improvement, and assurance so that best practices are applied throughout the health care arena. Dr Mensah clearly and repeatedly stated that nurses must be the major players in making these needed changes. Again, he challenged PCNA nurses to be at the forefront of prevention at all levels. He provided a strong call to action with specific recommendations for PCNA's support of the Healthy People 2010 Partnership, our participation on the Public Health Action Plan for Heart Disease and Stroke, and ongoing partnership with the CDC, DHHS, and NINR. His final challenge was to be visible and active at the table for the Healthy People 2020 Partnership!
Genetics and Dyslipidemia: Is It Genetics or Is It Environment?
Donna Arnett, PhD, MSPH, Mayo Professor at the University of Minnesota, described how her interest in genetics evolved from her basic background as a nurse involved in research. She posed the question "Why are some people responsive to diet and drugs for the treatment of dyslipidemia while others are not?" Her clear presentation provided the current research findings and areas under investigation in genetics research that help to address the question. For example, 55% of the variation in triglycerides may be explained by familial factors. Identification of genetic loci that contribute to variation in the response of triglyceride under specific environmental contexts will provide new insight into pathways and mechanisms, opening up new avenues for prevention and/or treatment of elevated triglycerides in the future.
She concluded her talk with examples of the role of genetics in the prevention and treatment of cardiovascular disease.
In Quest of the Magic Diet
Kristine Clark, PhD, RD, FACSM, is director of sports nutrition in the Department of Athletics and professor of nutrition at Pennsylvania State University. In an energizing presentation, Dr Clark provided a historical perspective and comparison of current "best selling" diets. She pointed out that the successful ingredients in each case are the limitation of calories, not the types of nutrients. She introduced the concept of energy balance used to explain weight gain and prevention, the best strategy to employ to attack the growing epidemic of obesity. To prevent weight gain, calories eaten must equal or be less than calories expended through normal daily living and purposeful physical activity. Dr Clark said that the jury is still out on whether extremely low carbohydrate diets, like the Atkins or South Beach diets, are safe in the long term or whether diets banishing fats, like the Ornish or DASH diets, are more healthful. She reminded the audience that there is no "silver bullet" and that when there is weight loss without lifestyle change, lost weight will inevitably find its way home.
Cardiorespiratory Fitness, Fatness, and Risk of Diabetes CVD and Mortality: What Should I Tell My Patients?
Steven Blair, PED, MS, BA, President and CEO of the Cooper Institute in Dallas Texas showed the audience convincing empirical evidence that obese individuals who are fit have a much lower risk of mortality than do lean individuals who are unfit, and that low cardiorespiratory fitness in overweight or obese men is as hazardous as having diabetes, smoking, or having high levels of cholesterol or blood pressure. In addition, the prevalence of low fitness is substantially higher than these other conditions in overweight or obese men. Dr Blair also reported data suggesting that low fitness, which is caused by sedentary living habits, is more important than obesity as a predictor of mortality. He emphasized that 30 minutes of moderate intensity physical activity accumulated over the course of the day, on most days of the week, provides important health benefits.
Innovative Models for Managing Heart Failure
Nancy Albert, MSN, RN, CCNS, CCRN, CNA is manager of Clinical Investigations Thoracic and Cardiovascular Surgery and the Heart Failure Disease Management Program at the Kaufman Center for Heart Failure at the Cleveland Clinic. In her popular breakout session, Albert described disease management as a multidisciplinary service delivery for chronic illness care that is a systematic approach versus episodic care for acute problems. It involves the continuous evaluation of health status and outcomes measures with the goal to improve overall health, enhance quality of life, and lower the cost of care. She provided examples of lessons learned in the outpatient arena that were applied and expanded as acute care management models. She further challenged cardiac nurses, especially advanced practice nurses, to use their dynamic leadership skills and expanded clinical roles to promote a disease management framework that moves beyond acute episodic care.
10th Annual PCNA Symposium Poster Abstract Winners
Adolescent Lipid Clinic
First Place-Patient Management & Education Counseling Category
Julie Foxton HEART UK, Maidenhead, UK and S. Mathews and G. Shortland Llandough Hospital, Cardiff, UK
Familial hypercholesterolemia (FH) is a genetic disorder that leads to excessively high circulating levels of cholesterol. Undiagnosed and untreated FH can lead to premature death from coronary heart disease (CHD). Approximately 119,000 people (1 in 500) have FH in the UK; of these about 15,000 are children. The service currently offered to teenagers with FH is poor. These children, usually detected by family screening after a parent has died or suffered a myocardial infarction, need more than a conventional clinic appointment. The objective of this clinic (four, 3-hour sessions held a month apart at a local sports centre) was to empower the adolescents to accept their FH positively and to take control of their condition with respect to diet, fitness, controlling risk factors, and taking medication, if required. The program also provides the adolescents and the parents with a support network of peers and professionals. The children and adults were separated for the training and reunited for feedback before the close of the session. Knowledge of their condition and risk reduction for CHD was greatly enhanced. All adolescents showed an improved fitness level (mean bleep test scores rising from 5.2 to 8.0 over the four sessions), with lower 1 minute recovery pulse rates. Low-density lipoprotein cholesterol was reduced by 10% in the adolescents. Engaging adolescents is challenging. The program developed here was well received and results show that the adolescents and adults were motivated to continue the lifestyle changes needed to reduce the risks of developing CHD.
Metabolic Syndrome Patients in an Ornish Intensive Lifestyle Change Program Exhibit Higher Perceived Stress
First Place-Clinical/Database Research Category
Mariam Kashani, Elaine Walizer, Marina Vernalis, and Debra Marshall Walter Reed Army Medical Center, Washington, DC
Background: It had been proposed that psychological stress is a mediator of metabolic syndrome (MS).
Objective: To compare psychometric profiles between patients with and without MS in an Ornish lifestyle intervention program.
Methods: Baseline to 3-month assessment of MS patients enrolled as part of a larger, prospective, 1-year, single-arm trial of the Ornish program (10% fat vegan diet, exercise, stress management, group support) in participants with or at risk for coronary artery disease (CAD). Validated measures of perceived stress, hostility, depression, and mental functional ability were collected in this study.
Results: Of 133 patients reaching the 3-month endpoint, 79 (mean age 59 years; 28% female; 65% with CAD) met NCEP metabolic syndrome criteria compared to 54 (mean age 60 years; 35% female; 69% with CAD) without MS. Program adherence was more than 70% in both groups. Baseline and 3-month perceived stress scores were significantly higher in the MS group. Within groups there was improvement in the perceived stress scores at 3 months (MS, P = .005; non-MS, P = .034) with no significant difference between groups. No statistical differences were noted in baseline and 3-month scores for hostility, depression, and mental functional ability.
Conclusions: Patients with MS have evidence of increased perceived stress that improves significantly with intensive lifestyle change. To optimize outcomes, attention to psychosocial stress as a modifiable risk factor may be particularly important, along with diet and exercise.