Cardiac Rehabilitation Nurses Research Articles

Heart health champions: how to develop student nurses as role models for cardiovascular health

Abstract Background Nurses as health promotors are optimally placed to identify cardiovascular disease risk factors and discuss behaviour change strategies for modifiable risk factors, but most undergraduate curriculums lack detailed content regarding these topics. Unfortunately evidence indicates that student nurses often demonstrate risky behaviours such as smoking, physical inactivity, excessive alcohol consumption and poor nutritional choices. As nursing is a pressurised career with long shifts and often challenging emotional encounters, it can be easy to overlook personal health behaviours. Purpose Given that nursing students are our potential health promotors of the future, we aimed to enhance cardiovascular knowledge and behaviour change awareness in their undergraduate education by implementing a co-designed digital educational resource - ASMOSUS. It sought to embed knowledge and risk assessment of cardiovascular disease risk factors, while motivating and sustaining behaviour change within undergraduates, facilitating them to make healthier lifestyle choices themselves and act as role models for patients. We developed roles of ‘Heart Health Champions’ within university and clinical placements, which is novel for both clinical practice and Higher Education Institutes. Methods Any nursing student who had received the ASMOSUS digital educational resource in the first semester of their undergraduate program and had an interest in further knowledge acquisition and health promotion amongst their peers were invited to become a Heart Health Champion. Alongside the recruitment of Heart Health Champions the cohort received cardiovascular risk factor specific educational sessions on physical exercise, smoking and vaping cessation, nutrition and alcohol consumption. Results We recruited 9 Heart Health Champions from the cohort representing all fields of undergraduate nursing. These students have undertaken 30 hours of required participation, leading to a university recognised qualification- FutureReady on graduation. This included attending cardiac risk and prevention training with cardiac rehabilitation nurses. They have taken the initiative to plan activities such as a sponsored walk, a ‘dancercise' class and support for their peers in harnessing healthy lifestyle behaviours through role modelling and motivational interviewing techniques. Results demonstrate that these sessions and student led activities are well attended and positively evaluated, which shows that including cardiovascular prevention techniques in undergraduates is feasible and acceptable. Conclusion Heart Health Champions are a valuable asset and can promote modifiable risk factor change amongst their peers and may help to maintain a healthy lifestyle. Further Heart Health Champions will be recruited over the next undergraduate nursing cohorts with a planned study to explore their effectiveness.

Cardiovascular Risk Factors Among First-Degree Relatives of Patients with Premature Cardiovascular Disease in Malta. Baseline Findings from the CRISO Project.

A family history of premature atherosclerotic cardiovascular disease (ASCVD) confers a greater risk of developing ASCVD. However, the prevalence of ASCVD risk factors among asymptomatic Maltese adults with parental or fraternal history of premature ASCVD is unknown. The study aimed to evaluate and compare their risk with the general population. Posters to market the project were distributed in cardiac rehabilitation areas. Patients with premature cardiovascular disease facilitated recruitment by informing their relatives about the project. Medical doctors and cardiac rehabilitation nurses referred first-degree relatives. Posters were put up in community pharmacies, and an explanatory video clip was shared on social media for interested individuals to contact researchers. Those eligible were enrolled in a preventive cardiology lifestyle intervention. Their data were compared with the risk in the general population. Many first-degree relatives had a suboptimal risk profile, with 60% (N = 89) having a total cholesterol level of >5.0 mmol/L; 54% having a low-density lipoprotein-cholesterol level of >3 mmol/L; 70.5% being overweight/obese, with 62% having a waist circumference greater than the recommended values; 34.8% having hypertension; 56.2% being inadequately adherent to the Mediterranean diet; 62% being underactive, with 18% being sedentary; and 25.8% being smokers. First-degree relatives had significantly higher proportions of underactive lifestyle (p = 0.00016), high body mass index (>25kg/m2) (p = 0.006), and systolic blood pressure (p = 0.001) than the general population, with 30% having metabolic syndrome. This study determined the prevalence of lifestyle, biochemical, physiological, and anthropometric cardiovascular risk factors among asymptomatic first-degree relatives of Maltese patients with premature ASCVD. First-degree relatives had considerable prevalences of an underactive lifestyle, hypertension, and obesity, suggesting better screening and early risk factor intervention are needed to modify their risk of ASCVD.

Preparedness of Cardiac Rehabilitation Nurses

Preparedness of Cardiac Rehabilitation Nurses

Application of food exchange portion method in home-based nutritional intervention for elderly patients with chronic heart failure

BackgroundThe home treatment of elderly patients with chronic heart failure (CHF) is often accompanied by malnutrition, which increases the risk of re-hospitalisation and affects the prognosis. Therefore, how to effectively improve the nutritional self-management of patients is a current focus of medical research. This study aims to test the effect of home-based nutritional intervention method on improving the nutritional status of elderly patients with CHF.MethodsA total of 90 hospitalised elderly patients with CHF were randomly divided into the experimental group (n = 45) and the control group (n = 45). The patients in both groups were given standardised drug therapy and their nutritional status was evaluated using a body composition analyser prior to discharge (protein, body fat percentage, visceral fat area, skeletal muscle, upper arm muscle circumference, left lower limb and right lower limb muscle mass), with the cardiopulmonary function evaluated using a six-minute walk test and the metabolic equivalents method. The control group was given general nutrition education and routine dietary guidance from cardiac rehabilitation nurses, while the experimental group was given an individualised nutrition prescription by dietitians based on the evaluation results, according to which one-to-one food exchange dietary intervention training was given until the patients mastered the process.ResultsThe nutritional indexes at the end of the study were significantly higher in the experimental group than in the control group and were higher than those before the intervention (P < 0.05). The muscle circumference of the upper arm, the muscle mass of the left lower limb and the right lower limb had no statistical significance following the intervention compared to the control group and before the intervention (P > 0.05). The cardiopulmonary function indexes were significantly better in the experimental group at the end of the study than before the intervention and were better than those in the control group, with statistically significant differences (P < 0.05), while no significant changes were observed in the control group before and after the intervention (P > 0.05).ConclusionThe home-based nutritional intervention method of food exchange portions can effectively improve the nutritional status of elderly patients with CHF, with the distribution of visceral fat more reasonable and the cardiopulmonary function and exercise endurance improved.

Report from the Northern Ireland Heart Failure Nurse Forum's educational meeting

This year, the Northern Ireland Heart Failure Nurse Forum relaunched with the aim of supporting, developing and promoting the essential role of heart failure specialist nurses in Northern Ireland. One of their first priorities was to host an educational meeting for their members, colleagues working in cardiac rehabilitation and cardiology nurses. This report summarises the content of the day, highlighting some topical issues in 2022.

Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods

We compared the odds of smoking cessation at 2-months post-myocardial infarction (MI), before and after implementing routines optimizing use of evidence-based smoking cessation methods, with start during admission. The following routines were implemented at six Swedish hospitals: cardiac rehabilitation nurses offering smokers consultation during admission, optimizing nicotine replacement therapy and varenicline prescription, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months before (n smokers/n admitted = 188/601) and after (n = 195/632) routine implementation were compared. Secondary outcomes included adherence to implemented routines and assessing the prognostic value of each routine on smoking cessation. After implementation, a larger proportion of smokers (65% vs. 54%) were abstinent at 2-months (OR 1.60 [1.04–2.48]). Including only those counselled during admission (n = 98), 74% were abstinent (2.50 [1.42–4.41]). After implementation, patients were more often counselled during admission (50% vs. 6%, p < 0.001), prescribed varenicline (23% vs. 7%, p < 0.001), and contacted by telephone post-discharge (18% vs. 2%, p < 0.001). Being contacted by telephone post-discharge (adjusted OR 2.74 [1.02–7.35]) and prescribed varenicline (adjusted OR 0.39 [0.19–0.83]) predicted smoking cessation at 2-months. In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects for post-MI patients.

A045 An Exercise Based Cardiac Rehabilitation Programme is Associated with Significant Improvement in Psychological Health

A cardiac event is a major life event and is known to be associated with significant psychological distress in patients. Poor psychological responses to a cardiac event are associated with poorer long term both psychological and physical outcomes. This has been attributed to reduced adherence to cardiac rehabilitation recommendations [[1]Rao A. Zecchin R. Newton P.J. Phillips J.L. DiI Giacomo M. Denniss A.R. Hickman L.D. The Prevalence and Impact of Depression and Anxiety in cardiac rehabilitation: a Longitudinal cohort study.Eur J Prev Cardiol. 2020; 27: 478-489Crossref Scopus (47) Google Scholar]. Waikato DHB (WDHB) runs exercise programmes consisting of 6, weekly 2hr classes with educational and exercise Components. During classes, patients interact with each other and with cardiac rehabilitation nurses and can seek support. We seek to discover whether classes improve psychological health post cardiac event. Patients undergoing the exercise programme at WDHB in 2019 were asked to complete a 42point DASS score at the beginning and end of a course. The DASS score is a validated questionnaire of depression, anxiety and stress [[2]Lovibond P.F. Lovibond S.H. “The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories”.Behaviour Research and Therapy. March 1995; 33: 335-343Crossref PubMed Scopus (6865) Google Scholar]. Higher scores indicate worse psychological distress. 56 patients completed the initial questionnaire. 24 patients (43%) had scores suggestive of >mild psychological distress. Of these 24 patients, 16 completed both initial and final DASS questionnaires. Individual DASS scores changed -30.9%. Overall the cohort total DASS score fell 34.2% (p=0.0058 t-Test), indicating a significant improvement in psychological well-being at an individual and cohort level. In our study, there is a significant burden of psychological distress post cardiac event. An exercise cardiac rehab programme was associated with significant improvement in psychological health. Further studies are required to elucidate what components of the programme are associated with this improvement and whether these improvements are associated with long term prognostic gains.

Nurses' perceptions of feedback from cardiac rehabilitation registries: a qualitative study across the UK and Denmark

Background/Aims Feedback on performance is a widely used strategy aiming to improve quality of care; however, limited research exists regarding nurses' perceptions of feedback. This article explores cardiac rehabilitation nurse leads' perceptions of the feedback provided through two national registries. Method This was a qualitative study which used semi-structured interviews. Cardiac rehabilitation nurses (n=12) were strategically recruited across the UK and Denmark. The transcribed interviews were analysed using content analysis, and differences and similarities were identified. Results Overall, five themes emerged; accessibility, reliability, usefulness, relevance and attitudes towards public reporting. In the UK, the nurses perceived that data regarding feedback were accessible, trustworthy, useful and reflected the important elements in cardiac rehabilitation. However, in Denmark, the nurses perceived that feedback data were unavailable, had reliability issues and only partly reflected the important aspects of cardiac rehabilitation. Nurses in both countries were ambivalent towards public reporting. Conclusions In order to facilitate high quality service delivery and improvement, registries should consider cardiac rehabilitation nurse leads' perceptions when delivering feedback.

Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT.

Around 19% of people screened by UK cardiac rehabilitation programmes report having moderate or severe symptoms of depression. These individuals are at an increased risk of cardiac mortality and morbidity, reduced quality of life and increased use of health resources compared with their non-depressed counterparts. Maximising psychological health is a goal of cardiac rehabilitation, but psychological care is patchy. To examine the feasibility and acceptability of embedding enhanced psychological care (EPC) within cardiac rehabilitation, we tested the feasibility of developing/implementing EPC and documented the key uncertainties associated with undertaking a definitive evaluation. A two-stage multimethods study; a feasibility study and a qualitative evaluation, followed by an external pilot cluster randomised controlled trial (RCT) with a nested qualitative study. UK comprehensive cardiac rehabilitation teams. Adults eligible for cardiac rehabilitation following an acute coronary syndrome with new-onset depressive symptoms on initial nurse assessment. Patients who had received treatment for depression in the preceding 6 months were excluded. The EPC intervention comprised nurse-led mental health-care co-ordination and behavioural activation within cardiac rehabilitation. The comparator was usual cardiac rehabilitation care. Measures at baseline, and at the 5- (feasibility and pilot) and 8-month follow-ups (pilot only). Process measures related to cardiac team and patient recruitment, and participant retention. Outcomes included depressive symptoms, cardiac mortality and morbidity, anxiety, health-related quality of life and service resource use. Interviews explored participant and nurses' views and experiences. Between September 2014 and May 2015, five nurses from four teams recruited participants into the feasibility study. Of the 203 patients screened, 30 were eligible and nine took part (the target was 20 participants). At interview, participants and nurses gave valuable insights into the EPC intervention design and delivery. Although acceptable, the EPC delivery was challenging for nurses (e.g. the ability to allocate sufficient time within existing workloads) and the intervention was modified accordingly. Between December 2014 and February 2015, 8 out of 20 teams approached agreed to participate in the pilot RCT [five were randomised to the EPC arm and three were randomised to the usual-care (UC) arm]. Of the 614 patients screened, 55 were eligible and 29 took part (the target was 43 participants). At baseline, the trial arms were well matched for sex and ethnicity, although the EPC arm participants were younger, from more deprived areas and had higher depression scores than the UC participants. A total of 27 out of 29 participants were followed up at 5 months. Interviews with 18 participants (12 in the EPC arm and six in the UC arm) and seven nurses who delivered EPC identified that both groups acknowledged the importance of receiving psychological support embedded within routine cardiac rehabilitation. For those experiencing/delivering EPC, the intervention was broadly acceptable, albeit challenging to deliver within existing care. Both the feasibility and the pilot studies encountered significant challenges in recruiting patients, which limited the power of the pilot study analyses. Cardiac rehabilitation nurses can be trained to deliver EPC. Although valued by both patients and nurses, organisational and workload constraints were significant barriers to implementation in participating teams, suggesting that future research may require a modified approach to intervention delivery within current service arrangements. We obtained important data informing definitive research regarding participant recruitment and retention, and optimal methods of data collection. Consideration should be given to the delivery of EPC by dedicated mental health practitioners, working closely with cardiac rehabilitation services. Current Controlled Trials ISRCTN34701576. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 30. See the NIHR Journals Library website for further project information.

An evaluation of the prevalence of Diabetes and Pre-Diabetes in a Cardiac Rehabilitation nurse led PCI clinic at University Hospital Limerick

Introduction: It is estimated that there are approximately 190,000 people in Ireland with diabetes, with type 2 diabetes accounting for approximately 90% of all cases. The Institute of Public Health predicts that the prevalence of diabetes will increase from 4.5% in 2007 to 5.9% of the population by 2020. Recent data shows 5.5% adults aged 50 years and over in Ireland have pre-diabetes, placing them at increased risk of developing type 2 diabetes in the future. Purpose: We set out to evaluate the prevalence of Diabetes & Pre-Diabetes in patients attending the nurse-led Percutaneous Coronary Intervention (PCI) clinic by Cardiac Rehabilitation nurses at UHL and the management/follow-up of these patients once diagnosed. Methods: All patients discharged from the Cardiology department in UHL following PCI are reviewed at the PCI clinic by Cardiac Rehabilitation nurses 4-6 weeks later where Fasting Glucose (FG) & HbA1c were reserved. All patients who attended the Cardiac Rehabilitation nurse led PCI clinic at UHL from Jan 2015 – Sept 2016 were included in this audit (N = 734 patients). Results: A total of 734 patients were included, mean age 65 years. There were significantly more male patients (n=553) than females (n=180). Indication for PCI were as follows: STEMI (n= 176), NSTEMI (n= 150), Angina (n= 330), Dyspnoea (n= 26), Syncope (n= 18), Other (n= 34). There were 107 known diabetic patients in this cohort (14.6% of total patients), mean HbA1c – 63mmol/mol & mean FG 9.3mmol/L. However, of interest was the proportion of patients newly diagnosed as diabetic on the basis of this test. 113 patients had HbA1c ≥48mmol/L and a further 91 patients had FG ≥ 7mmol/L. This resulted in 204 patients (33%) being diagnosed as diabetic. Furthermore, we analysed results of patients in the ‘pre-diabetes’ range - HbA1c 42-47 &/or FG 6.1-6.9. This yielded very interesting results. 140 (22%) patients had HbA1c 42-47mmol/mol & a further 57 (9%) patients had FG 6.1-6.9mmol/L. This resulted in a further 31% of patients being categorized as ‘pre-diabetes’. Patients newly diagnosed Diabetic & those in the Pre-Diabetes range are primarily referred back to their GP - the Cardiac Rehabilitation CNS will write to GP with results and request follow-up. The Cardiac Rehabilitation CNS has forged links with community programmes – DESMOND and CODE where patients can be referred by the CNS directly for further education and support. Conclusion: It is estimated that each year, the Irish state spends €350m on Diabetes care, 59% of which is spent on treating the complications of the disease. Early identification of patients and initiation of treatment can reduce the development of complications of diabetes and therefore testing for diabetes in high risk asymptomatic patients is recommended & very beneficial. The integrated care with community programmes takes pressure off hospital services and ensures a high level of care to patients in the community. References available on request .

P2499Myocardial infarction patients more often reach treatment goals for low-density lipoprotein at centres where cardiac rehabilitation nurses adjust statins - the Perfect-CR study

P2499Myocardial infarction patients more often reach treatment goals for low-density lipoprotein at centres where cardiac rehabilitation nurses adjust statins - the Perfect-CR study

Educational Preparation, Roles, and Competencies to Guide Career Development for Cardiac Rehabilitation Nurses.

Cardiac rehabilitation is one of the most widely recommended strategies to reduce the burden of cardiovascular disease. The multicomponent nature of cardiac rehabilitation programs requires a multidisciplinary team of healthcare professionals including nurses who are equipped with extensive knowledge and skills. However, there is a lack of a comprehensive, explicit career pathway that contains academic and clinical development to prepare nurses to become cardiac rehabilitation specialists. The aim of this study is to identify the 3 essential components for cardiac rehabilitation professionals: (1) educational preparation, (2) role/responsibility, and (3) competency to inform the framework of career development for cardiac rehabilitation nurses. Through scoping review, 4 stages from the methodological framework of scoping review by Arksey and O'Malley (Int J Soc Methodol. 2005;8:19-32) were used. Some attempts have been made in developing frameworks of career development for cardiac rehabilitation professionals with these 3 components through guidelines/standards and core curriculum development worldwide, among which the United States is the only country with a well-established system including guidelines for cardiac rehabilitation/secondary prevention programs, a position statement in terms of competencies, and certification examination for cardiac rehabilitation professionals. Nevertheless, further development and integration of these efforts, specifically for cardiac rehabilitation nurses, are required. It is vital to raise the awareness of the significant contribution that appropriately educated and trained nurses make in reducing the global burden of cardiovascular disease through cardiac rehabilitation. Therefore, action on establishing a system of comprehensive, clearly defined career development pathway for cardiac rehabilitation nurses worldwide is of immediate priority.

Personalised discharge care planning for postmyocardial infarction patients through the use of the Personalised Patient Education Protocol - implementing theory into practice.

This study aims to evaluate the service impact of the integration of an evidence-based instrument - the Personalised Patient Education Protocol - into an existing postmyocardial infarction care pathway. Recent research indicates that while better patient health outcomes can be achieved when care planning is personalised, delivery staff feel less satisfied and less confident in its provision. To achieve a shift to personalised care, innovations are needed to enable an effective transition for staff. A service evaluation using a patient survey and nurse interviews. A longitudinal patient survey measured changes in patient illness beliefs, cardiac diet and exercise self-efficacy, anxiety, depression and quality of life study of a patient cohort of 74. Paired t-tests analysed the effects before and after the implementation of the Personalised Patient Education Protocol. Cardiac rehabilitation nurses who implemented the Personalised Patient Education Protocol were interviewed and a patient survey identified perceptions of the usefulness of the service innovation. Analysis of change from baseline to three months results showed statistically significant changes in Illness Belief component 'Understanding' and the Dartmouth Quality of Life 'General Health'. The integration of the Personalised Patient Education Protocol into the existing discharge process identified service improvements for cardiac nurse training and care pathway delivery, while patients identified the level and frequency of their use of the protocol following discharge. The introduction of the Personalised Patient Education Protocol succeeded in increasing patient engagement, facilitated a more patient-centred service by enabling practitioners to systematically provide personalised patient education, and gave patients a postdischarge structure to better follow-up their illness concerns with health professionals in the community. Integration of the Personalised Patient Education Protocol into an existing postmyocardial infarction care pathway enabled nurses to systematically respond to individual patients' illness beliefs and expectations.

Factors influencing female patients’ recovery after their first myocardial infarction as experienced by cardiac rehabilitation nurses

Background: In the developed part of the world, coronary heart disease is the major cause of death and is one of the leading causes of disease burden. In Sweden, more than 30,000 people per year are affected by myocardial infarction and out of these approximately 40% are women. Nearly 70% of the women survive and after a myocardial infarction a recovery process follows. Today’s health care focuses more on treatment, symptoms and risk factors than on the individuals’ perceptions of the recovery process. Aim: To explore cardiac rehabilitation nurses’ experiences of factors influencing female patients’ recovery after their first myocardial infarction. Methods: Twenty cardiac rehabilitation nurses were interviewed. The study was conducted using qualitative content analysis. Results: The cardiac rehabilitation nurses experienced that women’s recovery after a first myocardial infarction was influenced whether they had a supportive context, their ability to cope with the stresses of life, if they wanted to be involved in their own personal care and how they related to themselves. Conclusions: Women’s recovery after a myocardial infarction was influenced by factors related to surroundings as well as own individual factors. The underlying meaning of women’s recovery can be described as the transition process of a recovery to health. Our findings suggest that a focus on person-centered nursing would be beneficial in order to promote the every woman’s personal and unique recovery after a myocardial infarction. Finally, the cardiac rehabilitation nurses’ experiences of factors influencing male patients’ recovery after their first myocardial infarction should be important to investigate.

Abstract 288: Secondary Prevention Following Coronary Artery Bypass Surgery: The Need For a Continuum of Care

Purpose: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. This study assessed the influence of a multidisciplinary educational program on disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following CABG. Methods: Using a prospective, randomized, controlled design, adults undergoing CABG completed surveys at discharge, 3 months, and 12 months, assessing disease understanding and motivation to reduce cardiovascular risk. Four to six weeks after CABG, intervention subjects completed an educational program involving group discussions and individual counseling with pharmacists, dietitians, and a cardiac rehabilitation nurses. The primary endpoint was a composite score of reduced risk factors, medication use among those eligible, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points. Results: The final analysis included 98 subjects (I=49, C=49). The composite score was not different between groups (I=12.8±4.5 points, C=12.7±4.9 points, p=0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes could not be attributed to our intervention. Medication use declined at 3 and 12 months after CABG without significant differences between the groups. Conclusions: Disease understanding, motivation to reduce risk, and medication use is robust at hospital discharge but declines with time and was not improved by our intervention. These findings are concerning and warrant further study.

Comparison of Cardiac Rehabilitation and Acute Care Nurses Perceptions of Providing Sexual Counseling for Cardiac Patients

: The purpose of this study was to examine the differences between outpatient cardiac rehabilitation (CR) and acute care nurses perceived barriers and clinical practices of providing sexual counseling for myocardial infarction patients. : A nonexperimental descriptive, comparative research design with convenience sampling was used to survey CR and acute care nurses using the Survey of Sexuality Related Nursing Practice-Myocardial Infarction questionnaire. : A total of 320 nurses (81 CR nurses, 239 acute care nurses), in midwestern states completed the survey. Using ANCOVA analyses with age, work status, and education level as covariates, findings demonstrated CR nurses had significantly higher levels of role responsibility (F[4, 315] = 5.4, P < .05) and implementation of sexual counseling in clinical practice (F[4, 315] = 9.1, P < .0001). : Findings from this study further elucidate the influence of practice settings on the actual implementation of patient education and counseling of cardiac patients regarding sexual functioning. Outpatient CR nurses reported fewer barriers and reported higher rates of implementing sexual counseling into their practice. These findings support the importance of CR referral to provide both physical and psychosocial rehabilitation after a cardiac event. Findings bring to light the need to address the gap in practice to meet the perceived unmet needs of patients regarding their concerns of sexual functioning while hospitalized and for those patients who may not enroll in CR after hospital discharge.

Improving Outcomes for Acute Coronary Syndrome Patients in the Hospital Setting

A treatment gap exists between published guidelines for secondary prevention of cardiovascular disease and application of these guidelines in clinical practice. The "Get With The Guidelines" program is a quality initiative developed by the American Heart Association to help acute care providers bridge this gap, thereby decreasing morbidity and mortality from cardiovascular disease. This article describes how cardiac rehabilitation nurses successfully implemented the program using a prospective case-management model in the acute care setting. An overview of the program including purpose, benefits, tools, and resources is provided along with start-up considerations, potential barriers, training needs, and keys to success.

Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization

A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes. The primary goals of the CPCRS are to increase the number of CAD patients on lipid-lowering therapy, manage medications shown to decrease the risk of future CAD-related events, assist in the monitoring and control of other diseases that increase cardiovascular risk, provide patient education and recommendations for nonpharmacologic therapy, and act as a CAD information resource for physicians and other health care providers. Using an electronic medical record and tracking database, the service works in close collaboration with primary care physicians, cardiologists, cardiac rehabilitation nurses, and other health care providers to reduce cardiac risk in the CAD population. Particular attention is given to dyslipidemia, blood pressure, diabetes mellitus, and tobacco cessation. Treatment with evidence-based regimens is initiated and adjusted as necessary. Over 11,000 patients are currently being followed by the CPCRS. A clinical pharmacy service in a large health maintenance organization provides cardiac risk reduction for patients with CAD and helps close treatment gaps that may exist for these patients.

Effectiveness of a planned strategy using cardiac rehabilitation nurses for the management of dyslipidemia in patients with coronary artery disease

Background Firm evidence exists for reduction in mortality and morbidity by lipid-lowering therapy in patients with coronary artery disease (CAD), yet a significant proportion remain untreated. This prospective study determined the effectiveness of a planned strategy of management using a cardiac rehabilitation nurse in achieving (1) lower 6-month low-density lipoprotein (LDL) levels and (2) a higher proportion of patients on pharmacologic therapy. Methods A cardiac rehabilitation nurse arranged for the lipid profiles and initiated pharmacologic therapy as soon as possible after the diagnosis of CAD. In phase 1, this planned-strategy intervention group (n = 80) was compared with the usual-care control group (n = 189), where the management was left at the discretion of the attending cardiologist with the assignment to the 2 groups based on the weekly on-call rotations of the attending cardiologists in a nonrandomized manner. In phase 2 of the study all patients (n = 366) were enrolled in the planned strategy of management. Results There were no significant differences in the baseline lipid values between the control and intervention groups. The 6-month cholesterol and LDL values and the percentage of patients on lipid-lowering medications were significantly better in the intervention group (P = .01). In phase 2 the results obtained in the intervention group were duplicated in a much larger group of consecutive patients. The 6-month (millimoles per liter) results in the control, intervention, and phase 2 groups (respectively) were cholesterol 4.92 ± 0.06, 4.60 ± 0.07, 4.30 ± 0.05; low-density lipoprotein 2.91 ± 0.06, 2.68 ± 0.07, 2.4 ± 0.06; high-density lipoprotein 1.18 ± 0.07, 1.12 ± 0.09, 1.10 ± 0.01; triglycerides 1.89 ± 0.12, 1.78 ± 0.09, 1.70 ± 0.05; and on medications 49%, 83%, and 84%. Conclusion A planned strategy of management with use of early pharmacologic therapy with a cardiac rehabilitation nurse assigned to obtain and follow lipid profiles and initiate therapy is more effective in controlling dyslipidemia than leaving the management to the cardiologist. (Am Heart J 2001;142:975-81.)

Education and training towards competency for cardiac rehabilitation nurses in the United Kingdom.

The development of cardiac rehabilitation in the UK, the evolution of the nursing role as a speciality, and the nursing role within the multidisciplinary team are briefly outlined. The potential impact of different professional backgrounds on the effectiveness of patient care is discussed, with particular reference to the differences between acute cardiac care and rehabilitation. Issues of professional competency are discussed, and core competencies for cardiac rehabilitation as specified by various professional associations are described. Current opportunities for preparation for practice in this field in the UK are outlined. Conclusions point towards the need for clearly specified competencies and an accredited programme of education and training to meet proposed standards for the management and rehabilitation of coronary heart disease (CHD) in the UK.