Article Content
American Heart Association 77th Scientific Sessions, November 7-10, 2004
The American Heart Association (AHA) 77th Scientific Sessions included many exciting presentations for nurses interested in cardiovascular disease prevention. During her address at the opening session, AHA President Dr Alice K. Jacobs discussed the renewal of trust in the healthcare sector through three pillars-technical competency, interpersonal competency, and agency. She defined agency as "doing what is best for patients by putting patients' welfare first." She further stated, "visible collaboration by academic medical centers to implement models of prospective preventive healthcare, rather than waiting for disease to occur, would inspire public trust."
In conjunction with the AHA Go Red for Women campaign, several sessions were related to women and heart disease, beginning with the Sunday morning program "Women and Cardiac Prevention: Are All Women Alike?" Dr Sandra Dunbar addressed the meaning of health and cardiovascular disease (CVD) for women. She noted that the trend for CVD-related deaths in women has increased, partly because women do not see themselves as vulnerable, yet they often have higher levels of risk factors. Risk factors for CVD were thoroughly addressed by Kathy Berra, PCNA board member. She identified the lack of recognition by women of certain risk factors, such as hypertension, diabetes, and elevated triglycerides, and yet these are powerful risk factors for women. For example, women with type 2 diabetes are at a higher risk for coronary heart disease and mortality compared to men. Berra acknowledged the need for greater clinical trial involvement among women and the need for effective treatments tailored to women.
Also as part of the Sunday morning program, PCNA board member Suzanne Hughes presented "Health Care Systems and Organizations: Are They Meeting the Needs of Women?" In framing the discussion of this question, she focused the discussion around research, clinical outcomes, and public education. Guidelines for National Institutes of Health-funded clinical trials mandate the inclusion of women, although enrollment criteria relative to age may continue to pose a challenge. Gender disparities in clinical outcomes remain evident, although the larger issue seems to be a gap in adherence to guidelines in both genders. Hughes closed with several insights regarding education initiatives of women in the community to raise the awareness of symptoms and the identification of CVD risk factors.
Dr Nanette Wenger, credited with leading women's issues and cardiac rehabilitation to the forefront of clinical cardiology, gave the Laennec Clinician/Educator Lecture, "Coronary Heart Disease in Women 2004: Problems, Progress, and Prospects." She spoke of differing clinical presentations of coronary heart disease (CHD) and management strategies in men and women. She discussed the underutilization of proven beneficial therapies, which contributes to less favorable outcomes in women. Dr Wenger expressed a call for preventive strategies and attention to specific features of CHD in women, thus improving the heart health of women.
One of the plenary sessions was a Red Dress Symposium, "Cardiovascular Disease in Women," which was held on Monday, November 8, the day all attendees were invited to wear something red. Topics included gender disparities in diagnosis, treatment and outcomes, the connection between atherosclerosis and osteoporosis, hormone replacement therapy, and gender trends in hypertension control and stroke. In the final presentation, Dr Sharonne N. Hayes addressed the rationale for gender-specific prevention guidelines. She discussed the new research since 1999 (when the previous guidelines were published), that estrogen is no longer a viable strategy for CVD prevention and the need to perform a global risk assessment/stratification in all women. She also addressed the need for education of the noncardiology community (primary care providers and the OB/GYN physicians) regarding the CVD prevention guidelines for women.
In a poster presentation, Dr Christine Albert reported that increased dietary intake of a-linolenic acid (ALA) correlated with reduced risk of sudden cardiac death and fatal coronary heart disease among women in the Nurses' Health Study. The study included 76,763 women who completed a food questionnaire in 1984 and were followed by updated questionnaires every 4 years for 16 years. Women in the highest ALA intake group had a 46% reduced risk of sudden cardiac death and a 21% reduced risk of dying from CHD than women in the lowest ALA intake group. The author speculated that certain types of fatty acids may prevent life-threatening arrhythmias. ALA is found in green leafy vegetables, certain nuts, canola oil, flaxseed oil, and some dressing and margarines.
In another poster presentation, Dr Edgar R. Miller reported on the meta-analysis of clinical trials of vitamin E supplementation versus placebo to determine if there is a dose-response effect on risk of death from any cause. Sixteen studies, from 1993 to 2004, were included in the analysis; doses of vitamin E ranged from 15 to 2000 IU/d, with a median intake of 400 IU/d. Results showed that those who took 400 IU/d or more were approximately 10% more likely to die than those who do not take vitamin E. On the other hand, a dose of 200 IU/d or less was not associated with increased risk of death.
Dr Tom Cook, a nurse researcher at Vanderbilt University, reported the results of an 8-week exercise intervention, designed to increase participation in leisure-time vigorous activities in third-grade children in three metropolitan Nashville schools of differing socioeconomic status. The intervention involved 24 exercise classes integrated into the school curriculum. Following the intervention, there was a significant increase in vigorous activities and a decrease in sedentary activities. African American, Hispanic, and Asian children had an increase of 1 point in the MET score in leisure-time activities, whereas Caucasian children showed a much smaller increase.
On Tuesday evening, the Council on Cardiovascular Nursing held the annual business meeting and dinner. Each year PCNA sponsors the Excellence in Clinical Practice Award. This year's award was given to PCNA board member, Dr Lynne Braun, from the Rush University Medical Center in Chicago. In addition, PCNA board member Mary Ann Champagne was inducted as a fellow in the Council on Cardiovascular Nursing.
PCNA Chapter Highlights
Remember Nursing Skills Lab 101, when students would experience some of the procedures that patients commonly undertook-like tasting pediatric syrups, receiving an intramuscular injection, or even undergoing nasogastric tube placement? Recently the Pennsylvania Regional Chapter of PCNA offered a similar experience at their meeting. Joyce Ross, MSN, CRNP, the coordinator of the chapter, seized an opportunity to partner with the University of Pennsylvania Hospital to offer all members a free electron beam CT scan (EBCT). The painless, 10-minute experience was seen as a way to introduce this "ultrafast heart scan" diagnostic modality to nurses who were most likely to provide patients education on this procedure. Using three-dimensional images, the EBCT scan detects and quantifies levels of calcium deposited on cholesterol plaques in the coronary arteries often prior to the development of stenotic lesions. A high calcium score is a sensitive, but not an especially specific, marker for coronary obstruction. Currently the scores are used to identify high-risk individuals who might benefit from aggressive risk factor reduction (RFR) therapy. At this time, the American Heart Association (AHA) identifies the most appropriate patients for EBCT scanning as those at intermediate risk for cardiac events-a group that includes all men over 45 and women over 50 with at least one added risk factor besides age. There was a large turnout for the meeting, with some nurses coming from as far as 200 miles away. Many nurses were shocked to see calcification on their own scans. It was an exciting day-and one that also boosted PCNA memberships.
Calcium scores can serve as a powerful risk reduction motivator for some patients. Enter the "nurse counselor and coach." To assist members in learning some of these skills, the Chicago Area PCNA Chapter held an excellent program on "Brief Motivational Interviewing," presented by Lola Coke, DNSc, MSN, CNS, a doctoral candidate at Rush University. This program was so outstanding that Coke is now consulting with several cardiac rehabilitation and lifestyle change programs across the Chicago area. Another member modeling an exciting role as a "Heart Coach" is Nancy Alcorn-Kell, BS, RN, manager of prevention and education at Edward Heart Hospital. She and her team counsel individuals who score high on their EBCT scans. Coupled with results from the Framingham Risk Assessment Tool, they take advantage of "that teachable moment" to help motivate clients needing to make difficult lifestyle changes. Her focus is not so much on what to do, but on how to instill the motivation needed to make those changes. Move over, Dr Phil. You have some nurse competition.
Braun Honored With Excellence in Cardiovascular Nursing Clinical Practice Award
Dr Lynne Braun was awarded the Excellence in Cardiovascular Nursing Clinical Practice Award at the recent AHA Council of Cardiovascular Nursing dinner meeting. This award is sponsored by the Preventive Cardiovascular Nurses Association (PCNA) to promote excellence in practice. Dr Braun has a stellar reputation as a nurses' nurse in the Chicago area (as well as nationally). She beautifully blends all the aspects of the advanced practice role into her everyday practice. She holds a dual teacher/practitioner role at the Rush Heart Institute, where her clinic serves as a national model. She brings to her practice expertise in many subspecialties, most notably lipid management, exercise therapies, hypertension management, and cardiac rehabilitation. Because of her expertise, leadership, and national recognition, she was a driving force behind the newly opened Women's Health Program at Rush University. Through her clinics, she has increased the visibility and respect of advanced practice nurses. And what makes this really exciting-Lynne is a PCNA member who currently sits on the PCNA Board of Directors. Congratulations, Lynne.
Reference
1. Rumberger JA. Electron beam (ultrafast) computed tomography for the evaluation of cardiac disease and function. available at: http://patients.uptodate.com/topic.asp?file=chd/38266&title=Heart+transplantatio.
PCNA Initiating International Presence
In the spring and summer of 2004, PCNA was invited to participate in two international scientific conferences: the Eighth World Congress of Cardiac Rehabilitation and Prevention held in Dublin, Ireland, and the 14th Annual Scientific Meeting of the Australian Society of Cardiac Rehabilitation, held on the Gold Coast in Australia. PCNA's "Get Tough on Angina" was presented by Kathy Berra and Barbara Fletcher in Dublin and Nancy Houston Miller in Australia.
The Eighth World Congress of Cardiac Rehabilitation attracted 1000 attendees from around the globe, and the National Australian Cardiac Rehabilitation Association was attended by 300 healthcare professionals, mainly from Australia and New Zealand. Both these scientific conferences offered PCNA an opportunity to market the organization as well as present the "Get Tough on Angina" Program beyond the boundaries of the United States.
The nurses attending the "Get Tough on Angina" session in Dublin were very happy to obtain the professional and patient educational materials. It was apparent that they had also recognized the need for providing support to patients with angina. In fact, several countries already were conducting programs for patients with angina. There did not appear to be major notable difference in healthcare from the international provider standpoint other than, perhaps, that nurses outside the United States seemed to have more time to provide patient education.
Over 50 nurses and other allied health professionals attended the "Get Tough on Angina" workshop in Australia. Like the Dublin session, all attendees were extremely enthusiastic about supporting patients with angina through their educational efforts. They offered their experiences conducting patient groups, including offering self-management techniques, and expressed interest in pilot-testing materials developed as part of this program. Both the United States and Australia offer similar services for rehabilitation and it was gratifying to hear that few differences exist in the way patients are educated.
PCNA plans to continue international involvement and hopefully attract more international members. Our next opportunity will be presenting two sessions at the Sixth International Conference on Preventive Cardiology to be held in Brazil in May 2005.
PCNA Participates in Milestone Meeting:
COMMITTED TO IMPROVING CARE FOR OLDER ADULTS
Twenty-six national specialty nursing associations gathered on October 4-5, 2004, in New York City, for an unprecedented meeting during which they shared their approaches to elder care and reached a higher level of commitment to integrating geriatric best practices within their ongoing educational activities. Jerilyn Allen, ScD, RN, FAAN, represented PCNA, a proud participating organization. The organizations were convened by Nurse Competence in Aging (NCA), a strategic alliance of the American Nurses Association (ANA), the American Nurses Credentialing Center (ANCC), and the John A. Hartford Foundation Institute for Geriatric Nursing at New York University's Steinhardt School of Education, Division of Nursing. Forty representatives of specialty nursing associations and staff from each NCA partner organization participated in the meeting, held at the Southgate Tower Hotel and facilitated by Mathy Mezey, EdD, RN, FAAN, director of the Hartford Institute.
More than half of all patients who receive care from nurse specialists are older than 65. Yet it is widely agreed that, whether nurses have been trained in oncology, critical care, psychiatry, or another specialty, most would benefit from additional training on symptoms and syndromes specific to older patients.
"There is a critical learning gap in care of older adults across the field of nursing," said Dr Mezey. "By bringing geriatric knowledge to nurses who are already highly educated and motivated, we can really change patient outcomes in hospital, long-term-care, and community settings."
The first day of the meeting featured panel discussions addressing issues specific to specialty nursing associations, including how associations lead the field in nursing, the role of nurse certification, and communication with members and other associations. On the second day of the meeting, breakout sessions focused on how specifically the organizations can identify opportunities to infuse geriatrics in the work they are already doing and further develop such efforts, whether individually or together. In these discussions, the groups identified areas in which they need technical assistance to fulfill their commitment to increase geriatric training and considered ways in which they might collaborate and network across their specialties.
The need for a workforce that is prepared to deliver quality healthcare to older adults was echoed by Linda J. Stierle, MSF, RN, CNAA, BC, chief executive officer of the American Nurses Association. "Geriatric competence combined with specialty expertise will have a tremendous impact on the nursing profession," she said. "It is tremendously rewarding to see so many specialty organizations energized and acting together on this important issue."
Organizations participating in the conference agreed to generate action plans to ensure the continuation of their commitment to enhancing members' geriatric skills and to make geriatric information easily attainable, such as by providing it on their websites. The specialty groups will also supply information to a central online geriatric resource, http://GeroNurseOnline.org.
"Many organizations have now embraced activities related to care of the older adult population, and they recognize that these activities must become embedded into association education, not thought of as projects with an end," said Dr Mezey. Indeed, many participants said they gained a clear sense of the path their organizations need to take and a sense of invigoration from the highly relevant forum.
NCA was initiated to help organizations move forward with activities to educate their members about the unique needs of older adults and to develop geriatric-care projects related to the needs of the specialty practice area. Nurses who wish to learn more about geriatric syndromes, their possible causes, and treatments can visit http://GeroNurseOnline.org for information.
PCNA-The Year in Review
This past year was a year of many successes for the Preventive Cardiovascular Nurses Association. As we continue our mission of promoting and supporting the role of nurses in the practice of cardiovascular risk reduction and disease management, education, member involvement, and building relationships with other organi-zations and industry also remain a high priority. Our current membership is now more than 1775. We have healthcare professionals throughout the United States, Canada, South America, and Europe and are continuing to expand and represent an ever-growing number of nurses in primary and secondary prevention.
Each year provides us with an opportunity for expanded networking, fostering professional development, and highlighting the field of preventive cardiovascular nursing as a rewarding career choice. This past year we increased opportunities for our members to be involved at the local and regional level of PCNA through the "Tell a Friend" About Women and Heart Disease campaign. Nationally, members were involved in the election of two new board members, submission of poster abstracts, and selection of speakers and topics for our 2005 National Symposium program. In addition, outstanding leadership was recognized at our National Symposium Leadership Luncheon. PCNA also developed and offered educational opportunities through Get Tough on Angina, the Journal of Cardiovascular Nursing (JCN), Diabetes-Cardiovascular Disease Took Kit, the PCNA National Symposium, and our newest educational publication entitled Insulin Resistance in the Patient with Cardiovascular Disease.
PCNA is dedicated to the continued education of nurses so that we may all rise to the challenge the current state of healthcare presents. The corporate support that we receive has a direct impact on our ability to create these educational opportunities. With the generous support of our sponsors, we have been able to provide scholarships to attend the National Symposium, produce educational products for our members, expand our website, provide the JCN to our members, and so much more. We are most appreciative of their continued support of our organization and would like to specifically thank our corporate partners, AstraZeneca, CV Therapeutics, GlaxoSmithKline, Merck/Schering-Plough, Guidant Foundation, and Pfizer; and our corporate members: Cholestech and Kos; Corporate Affiliates: General Mills Cheerios, Quaker Oats, LipoScience, and the Walnut Commission.
And of course, thank-you to all of our dedicated members who are making a difference in the lives of others. We look forward to another prosperous year in 2005!!
Section Description
The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.