PCNA Participates in Defining Cardiovascular Specialty Practice
Over the past 2 years, a dedicated group of 14 cardiovascular nurse leaders joined forces to become the Task Force of Cardiovascular Nursing Organization Representatives. Spearheaded by the American College of Cardiology Foundation's Working Group on Continuing Nursing Education, under the guidance of the American Nurses Association, these leaders have worked collaboratively to create a Scope and Standards for Cardiovascular Nursing that represents the breadth and diversity of this nursing specialty as practiced today.
In addition to the 15 Standards of Practice with related measurement criteria, this document includes the definition of cardiovascular (CV) nursing specialty and its practice environment, educational requirements for CV nurses, advanced practice CV nursing, the need for continuing professional development and lifelong learning, the status of specialty certification, practice characteristics, and future considerations.
The document was opened in late fall for public review through December 11, 2006. Task Force members are now completing the final integration of comments in hopes of publishing the long-awaited Scope and Standards for Cardiovascular Nursing document by Spring 2007.
PCNA Patient Education Tools
PCNA is proud to offer healthcare professionals and patients with a number of tools for home and clinic use.
PCNA Forms Online: Practical Information for Your Cardiovascular Risk Reduction Clinic-Medical Evaluation Forms, Assessment Tools, and Educational Materials
The PCNA Forms Online tool contains PDF templates of clinical forms and patient handouts that you can use in your cardiovascular disease risk reduction practice. These forms can be integrated into a patient's medical record and include patient assessment forms, contracts, flowcharts, follow-up plans and tools, patient education materials, and a list of online resources. To view the PCNA Forms Online tool, visit http://www.pcna.net.
Get Tough on Angina Patient Handbook
The Get Tough on Angina Patient Handbook is the most comprehensive educational resource currently available to patients with angina. This book provides detailed information on what angina is, what causes it, how to cope with symptoms, how to prevent angina attacks, and more. This handbook is available in English and Spanish and is provided free of charge to patients, their significant others, and healthcare professionals. Healthcare providers should distribute this handbook to patients when conducting the small educational group sessions or community seminars or for patients who want more detailed information on angina. These handbooks may be ordered by calling 1-866-488-1212. For more information on the Get Tough on Anginaprogram, visit http://www.pcna.net/publications/gtoa.php or http://www.lifeheart.com.
Get Tough on Angina Patient Brochure
The Get Tough on Angina patient brochure provides quick information on angina, how to reduce attacks, and how to cope with symptoms. Healthcare providers may distribute this free brochure to their patients directly or place a supply in waiting rooms of offices, clinics, rehabilitation centers, and hospitals. These brochures are available in English and Spanish and may be ordered by calling 1-866-488-1212. For more information on the Get Tough on Angina program, visit http://www.pcna.net/publications/gtoa.php or http://www.lifeheart.com.
Destination Heart Healthy Eating
This free educational resource offers materials to help the healthcare professional communicate a positive strategy for heart health. Visit http://www.bellinstitute.com/hearthealth for ordering information.
What's Missing in CholesterALL?
"What's Missing in CholesterALL?" was designed by PCNA to educate women about the importance of knowing and optimizing all of the components of the lipid profile, with a particular focus on the importance of high-density lipoprotein (HDL) in women.
It is estimated that 28 million women have low HDL (less than 50 mg/dL), which puts them at greater risk for heart disease. Despite this, a recent survey showed that most women do not know their HDL and LDL numbers, and many still do not know the difference between HDL and LDL.
Visit http://www.RaiseYourCholesterol.com or call 1-877-HDL-GOAL (877-435-4625) to order free brochures-a perfect way to educate your patients about this topic!
PCNA Represented Internationally
PCNA had several opportunities to fulfill its mission of promoting nurses as leaders in cardiovascular risk reduction and disease management at international conferences in December 2006.
Barbara Fletcher, PCNA board member and Clinical Associate Professor at the University of North Florida, represented PCNA at the Sociedad Chilena de Enfermeria en Cardiologia y Cirugia Cardiovascular (Chilean Society of Nurses in Cardiology and Cardiovascular Surgery) in Vina del Mar, Chile. More than 1,000 healthcare professionals attended this annual conference. Ms Fletcher presented several topics to attendees including: cardiovascular risk in children and adolescents; cardiovascular health and exercise; cardiovascular health and women; metabolic syndrome, obesity, and diabetes in cardiovascular health; and PCNA programs Get Tough on Angina and Tell a Friend About Women and Heart Disease. Thank you to PCNA member Maria Teresa Lira for her help in bringing PCNA to Chile.
On the other side of the globe, PCNA board members Kathy Berra and Nancy Houston Miller and PCNA Executive Director Sue Koob met with healthcare professionals in Hong Kong at the First Asian Preventive Cardiology & Cardiac Rehabilitation Conference in Wanchai, Hong Kong. The focus of the conference was "How far should we go for risk management?"
Ms Berra gave several talks including "Life Skills: Ten Easy Skills to Help Manage Stress for Cardiac Rehabilitation Program Participants" and "Coronary Artery Disease Prevention Utilizing Case Management to Improve Cardiac Rehabilitation Outcomes." Ms Houston Miller also presented on several topics including "Helping Patients with Chronic Stable Angina: A Patient and Community Education Program for Cardiac Rehabilitation Programs" and "Implementation of a Smoking Cessation Program."
Smoking Cessation: New (and Old) Pharmacotherapy as an Adjunct to Counseling
Tobacco abuse, specifically cigarette smoking, is the leading cause of preventable death worldwide. When counseling patients, the primary emphasis should be on the health consequences of smoking. This is especially true in cardiovascular prevention and rehabilitation settings.
Consumer education about the effects of tobacco products-combined with counseling, behavioral modification, and support groups-has long been the focus of smoking cessation programs. Today, a number of pharmacologic agents are available to help increase the success of smoking cessation attempts; in most cases, there should be no reason to delay trying such treatments.
Nicotine replacement therapy (NRT) has been the mainstay of pharmacological smoking cessation therapy. It includes chewing gum, skin patches, nasal spray, and inhalers and is designed to decrease the withdrawal symptoms by replacing nicotine in the blood. All forms of NRT increase the likelihood that a patient will succeed in smoking cessation attempts.
Several issues have led to research and development of non-NRT pharmacotherapies for smoking cessation. Nicotine patches can be associated with nicotine's toxic effects if there is continued smoking; this is especially a concern in patients after an acute myocardial infarction or in those with sustained hypertension. There is also concern for the use of NRT during pregnancy.
Nicotine withdrawal symptoms can persist even with adequate NRT, and a rebound phenomenon can occur with abrupt cessation. Some patients cannot tolerate local nasal irritation from the spray or inhaler, and the gum may be unpalatable and the nicotine poorly absorbed with acidic beverages. Compliance success rates with smoking cessation remain modest regardless of which method for delivery of NRT is used. Continuous abstinence rates for any form of NRT approximate 20% to 25%. Although the health risks of long-term NRT are smaller than those of continued smoking, pharmacotherapy that minimizes this risk and increases cessation rates would be a huge advantage.
Of the non-NRT pharmacological treatments, the slow release form of bupropion hydrochloride, an antidepressant with both adrenergic and dopaminergic actions, has been approved by the Food and Drug Administration (FDA) for smoking cessation. Bupropion sustained release (SR) replaces nicotine's neurochemical effects and nearly doubles cessation rates when compared with placebo. Still, the estimated abstinence rate with bupropion SR reaches only 30%.
A new class of pharmacotherapy has now become available as an aid to smoking cessation. Varenicline (Chantix(TM)) was approved early in 2006 by the FDA as a smoking cessation agent. It acts on the nicotinic acetylcholine receptor, which is responsible for many of the rewarding properties of tobacco use, largely via the release of dopamine. Varenicline's agonist actions at the receptor site allow for relief of nicotine withdrawal symptoms, whereas its affinity for blocking the receptor sites makes nicotine increasingly less rewarding.
Varenicline is intended to be started a week before the date the patient sets as a "quit date." Dosing is titrated from 0.5 mg in the morning for the first 3 days to 0.5 mg twice a day for the next 4 days to the target dose of 1 mg twice a day starting on the quit date and for 3 to 6 months thereafter. The gradual increase helps to ameliorate the most common adverse effect of varenicline-nausea. Taking this medication with food also helps to prevent nausea. There is a caution for use of varenicline in patient's with significant renal insufficiency, but there are no absolute contraindications.
Results from 5 major randomized controlled trials involving more than 5,000 patients were published late in the summer of 2006. Of these, 2 were identically designed double-blind controlled trials comparing varenicline to bupropion SR.1,2 Six months after the target quit date, varenicline maintained a cessation advantage over both placebo and bupropion SR. Results from standardized questionnaires were suggestive that varenicline was effective in both reducing acute withdrawal symptoms and reducing perceived rewarding properties of smoking.
Rimonabant (Accomplia(TM)), a cannabinoid receptor antagonist, has shown equivocal results in altering smoking behavior despite initial enthusiasm. The FDA has not yet approved this drug for use as a smoking cessation agent. Current and future advances in pharmacotherapies will help an increasing number of smokers to be ex-smokers. Cardiovascular prevention professionals must continue to use the best possible counseling and behavioral therapy while taking advantage of new and older pharmacotherapies to assist patients to become smoke free forever.
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