Celebrating Our 40th Anniversary!
The Council of Cardiovascular Nursing (CVN) promotes excellence in nursing care for patients and their families, ranging from primary prevention to the care of the critically ill. The CVN integrates cardiovascular nursing research into the American Heart Association's (AHA's) national research program and works to advance evidence-based practice by disseminating knowledge generated by all types of research. Importantly, we collaborate with other AHA scientific councils, cosponsor professional educational conferences, participate in writing scientific papers, and sponsor summer research scholarships for students.
Advanced Practice Corner
Depression and Coronary Heart Disease, Recommendations for Screening, Referral, and Treatment. A Science Advisorya from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research.1
Summary
The literature consistently shows that depression is 3 times more common in patients after an acute myocardial infarction than in the general population. Because of this, this Scientific Advisory advises a 2-step approach to identify depressed patients.
Step 1. 2-Item Patient Health Questionnaire (PHQ-2)
Over the past 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
If the patient answers yes to either question, then ask the patient to complete a brief 5-minute questionnaire, the 9-item Patient Health Questionnaire, because it generates a provisional depression diagnosis and a severity score that can be used for treatment selection.
Step 2. 9-Item Patient Health Questionnaire (PHQ-9)
Over the past 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling asleep, staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself, feeling that you are a failure, or feeling that you have let yourself or your family down
7. Trouble concentrating on things such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed. Or being so fidgety or restless that you have been moving around a lot more than usual
9. Thinking that you would be better off dead or that you want to hurt yourself in some way.
Questions are scored as 0, not at all; 1, several days; 2, more than half the days; and 3, nearly every day. Add together the item scores to get a total score for depression severity.
Overall, this Scientific Advisory by the American Heart Association is a comprehensive summary that recommends a strategy of increased awareness and screening for depression in patients with Coronary Heart Disease (CHD). Specifically, they recommend the following:
[black small square] Patients with CHD should undergo routine screening for depression.
[black small square] Patients with positive screening results should be further evaluated.
[black small square] Patients with CHD who are under treatment for depression should be carefully monitored for adherence to their medical care, drug efficacy, and safety with respect to their cardiovascular and mental health.
[black small square] Coordination of care between healthcare providers is essential in patients with combined medical and mental health diagnoses.
Research Corner
American Heart Predoctoral Fellowship, A Case Study
When Kelly A. Bosak ([email protected]) was earning her PhD in nursing at the University of Nebraska Medical Center, her clinical experiences as a nurse practitioner in a lipid clinic provided a rich supply of potential research topics. One of the main areas she was interested in was helping patients with metabolic syndrome overcome obstacles to implementing healthy lifestyle changes. For her dissertation, she developed a physical activity intervention delivered via the Internet to patients with metabolic syndrome. Internet interventions, from her perspective, had the potential to deliver strategies for health behavior change using evidence-based content; were accessible 24 hours a day, 7 days a week; could reach large numbers of people; and were consistent in their delivery compared with other intervention strategies currently available. However, she needed funding to help support her doctoral studies.
The American Heart Association (AHA) had the ideal support for Kelly Bosak, the predoctoral fellowship. The purpose of the AHA predoctoral fellowship is to help students initiate careers in cardiovascular and stroke research by providing research assistance and training. The target audience is postbaccalaureate, predoctoral full-time students working toward their degrees and seeking research training with a sponsor/mentor.
With the mentoring of her research advisor, Bernice Yates (or B.Y., second author) Kelly submitted a predoctoral fellowship application. She received 2 years of funding after her third submission. The stipend allowed her to cut back significantly on her work schedule and devote more time to her research. For her dissertation, Kelly Bosak developed and tested an Internet intervention to help patients with metabolic syndrome increase their physical activity levels. Excitedly, her abstract was submitted for presentation at the AHA Scientific Sessions and was accepted for a poster presentation (Figure 1).
The research focus of this program is broad, related to cardiovascular function and disease and stroke, clinical, basic science, bioengineering or biotechnology, or public health problems. The predoctoral fellowship is competitive, with a success rate of 36%, but an applicant who is unsuccessful may resubmit the application. The AHA has a new grant application research site: http://research.americanheart.org. Typically, applications are due twice a year, so it is not too early to start working on your application for 2009. Happy writing!
The Top 10 Major Advances in Heart Disease and Stroke Research, 2008
The American Heart Association compiles an annual list of the top 10 major advances in heart disease and stroke research. Achievements in 2008 include the following:
1. Breathing cleaner air
Smoke-free legislation and hospitalizations for acute coronary syndrome
2. The acute care of patients with myocardial infarction or stroke: Can we do better?
Hospital treatment of patients with ischemic stroke or transient ischemic attack using the "Get With the Guidelines" program; an organized approach to improvement in guideline adherence for acute myocardial infarction
3. Type 2 diabetes: What is the legacy of intensive treatment?
10-year follow-up of intensive glucose control in type 2 diabetes; long-term follow-up after tight control of blood pressure in type 2 diabetes
4. The epidemic of childhood obesity: Can anything be done?
A policy-based school intervention to prevent overweight and obesity
5. As we age-treating valvular heart disease
Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery and the European Society of Cardiology, in collaboration with the European Association of Percutaneous Cardiovascular Interventions
6. Stable coronary artery disease: what treatment is optimal?
Effect of percutaneous coronary intervention (PCI) on quality of life in patients with stable coronary disease
7. Selecting patients for prevention
Rosuvastatin to prevent vascular events in men and women with increased C-reactive protein
8. A platform for new hearts
Perfusion-decellularized matrix: using nature's platform to engineer a bioartificial heart
9. The building blocks of new hearts
Human cardiovascular progenitor cells develop from a KDR1 embryonic-stem-cell-derived population
10. Hypertension: who is too old to treat?
Treatment of hypertension in patients 80 years or older
American Heart Association Funding
The American Heart Association (AHA) offers many different types of research funding opportunities, and the Council of Cardiovascular Nursing (CVN) encourages our members to apply (Table 1). Submission dates vary from affiliate to affiliate so make sure you check you specific affiliate. Here is a summary of specific types of programs available from the AHA. CVN nurse scientists should pay particular attention to the Scientist Development Grant as a way toward advancing their research independence. Visit the AHA site for specifics regarding affiliate and national funding programs. Each affiliate may differ slightly so make sure you find your correct affiliate for funding opportunities.
Consider Becoming a Fellow in American Heart Association
Fellows are an identifiable, knowledgeable group of cardiovascular leaders with specialized expertise who may be called upon to develop scientific and position papers and to address issues beyond the scope of the council. Visit our Web page to see specific criteria. Even if you are not quite ready to apply this next year, review the criteria so you can earn this honor (http://www.americanheart.org/presenter.jhtml?identifier=3004210).
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