SECONDARY PREVENTION IN HEART DISEASE CATHY QUICK AUBURN UNIVERSITY/AUBURN MONTGOMERY EBP III

INTRODUCTION MORE THE THAN HALF OF ALL NON-COMMUNICABLE DISEASES (NCD) ARE CARDIOVASCULAR DISEASE (CVD) IN NATURE (AHA, 2013). CVD IS THE LARGEST SINGLE CONTRIBUTOR TO GLOBAL MORTALITY THAT ACCOUNTS FOR NEARLY HALF OF THE 36 MILLION NCD DEATHS RESULTING IN $863 BILLION IN GLOBAL COST (AHA, 2013).

TARGET POPULATION MEN AND WOMEN OVER THE AGE OF 18 WITH KNOWN CARDIAC DISEASE WHOM HAVE RECENTLY BEEN DISCHARGE FROM AN ACUTE CARE FACILITY

PICO QUESTION IN PATIENTS OVER 18 WITH KNOWN CARDIAC DISEASE WHO WERE RECENTLY DISCHARGED FROM AN ACUTE CARE FACILITY, HOW DOES FOCUSED EDUCATION ON MEDICATION COMPLIANCE AND ADHERENCE TO LIFESTYLE MODIFICATIONS COMPARE TO USUAL PATIENT EDUCATION IN PREVENTING FUTURE CARDIAC EVENTS OR PROCEDURES?

LITERATURE SEARCH THE TYPES OF EVIDENCE INCLUDE CLINICAL PRACTICE GUIDELINES (CPG), SYSTEMATIC REVIEWS, SINGLE STUDIES AND EXPERT COMMITTEE REVIEWS ON CVD, MEDICATION COMPLIANCE, AND LIFESTYLE MODIFICATIONS. THE TYPES OF LITERATURE SEARCH WERE BOTH QUALITATIVE AND QUANTITATIVE STUDIES. SEARCH STRATEGIES INCLUDED USING THE FOLLOWING DATABASES: ACADEMIC SEARCH PREMIER; CINAHL; COCHRANE LIBRARY (COCHRANE REVIEWS, COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS); EBSCOHOST; ERIC; HEALTH SOURCE: NURSING/ACADEMIC EDITION; MEDLINE; PSCHARTICLES; AND PSYCINFO AS WELL AS THE AMERICAN HEART ASSOCIATION (AHA) WEBSITE.

SUMMARY OF EVIDENCE THE STRONGEST POINTS OF THE APPRAISAL OF THE LITERATURE SUGGEST THAT BY ESTABLISHING A STRONG PATIENT-PROVIDER RELATIONSHIP THE CAREGIVER WILL HAVE AN EXCELLENT OPPORTUNITY TO PROVIDE THE NECESSARY EDUCATION TO MAKE LIFESTYLE MODIFICATIONS. THESE CHANGES WOULD INCLUDE SMOKING CESSATION, DIETARY CHANGES, WEIGHT MANAGEMENT, AND MEDICATION ADHERENCE. MAKING THESE MODIFICATIONS PATIENTS WOULD BE REDUCING THEIR RISK FOR CVD.

RECOMMENDATIONS BASED ON THE CRITICAL APPRAISAL AND REVIEW OF LITERATURE THE FOLLOWING RECOMMENDATIONS ARE MADE FOR THE PROJECT: 1) INCLUDE LIFESTYLE MODIFICATION, EDUCATION AND SUPPORT FOR PATIENTS WITH CHD AND ASSOCIATED RISK FACTORS. (GRADE A) 2) ASSESS FOR MEDICATION ADHERENCE AND IMPLEMENT STRATEGIES TO IMPROVE MEDICATION WHEN INDICATED. (GRADE A) 3) WOMEN WITH CHD MAY REQUIRE ALTERNATE STRATEGIES TO MEET THEIR SECONDARY PREVENTION GOALS (GRADE B)

SETTING FOR PROJECT DR ONYEKWERE’S OFFICE ANNISTON, AL POPULATION: PATIENTS OVER THE AGE OF 19 WITH KNOWN CARDIAC DISEASE TOTAL PARTICIPANTS=12

IMPLEMENTATION PLAN SMALL TEST OF CHANGE STEP 1: INCREASE OVERALL AWARENESS OF LIFE’S SIMPLE 7 TOOL STEP 2: CLINIC TEAM MEMBERS SELECTED STEP 3: REVIEW AND GATHER PATIENT INFORMATION STEP 4: IDENTIFY PATIENTS THAT MEET SOME OR ALL OF THE CRITERIA INCLUSION CRITERIA STEP 5: USE THE LIFE’S SIMPLE 7 TOOL TO MODIFY PATIENT’S PLAN OF CARE (MECHANISM TO ASSESS COMPLIANCE TO MEDS & LIFESTYLE, RISK FACTORS CHANGES, MAKING SURE APPROPRIATE REFERRALS WERE MADE)

EVALUATION PLAN EVALUATE THE USE OF THE LIFE’S SIMPLE 7 TOOL HAD AT IDENTIFYING A PATIENT’S KNOWLEDGE LEVEL OF HEART DISEASE, FROM THAT DATA DETERMINED HOW TO MODIFY THEIR PLAN OF CARE (MEDICATION ADHERENCE, OR LIFESTYLE MODIFICATIONS). FOUR TO SIX WEEKS LATER, A REPEAT LIFE SIMPLE 7 EITHER VIA PHONE OR IN OFFICE VISIT. TO COMPARE PRE/POST BMI AS WELL AS PRE/POST PHYSICAL ACTIVITY MEASURED IN DAYS/WEEK

RESULTS MEAN AGE: 67.9 WITH STANDARD DEVIATION 0F 14.05; MEDIAN AGE IS 69; WITH A RANGE FROM YEARS FEMALE: 8 ; MALE: 4 NONSMOKERS: 11; SMOKERS: 1 CAUCASIAN: 10; AFRICAN AMERICAN: 2 T VALUE = NS SOME CHANGE BUT NOT SIGNIFICANT

RESULTS

DUE TO THE SHORT LENGTH OF THE STOC AND THE ADVANCE AGE OF THIS SAMPLE SIGNIFICANT IMPROVEMENTS WERE NOT ACHIEVED HOWEVER IMPROVEMENT WAS IDENTIFIED LONG TERM OUTCOMES ARE CLINICAL CHANGES LIKE: RISK FACTORS REDUCED AT PREVENTING FUTURE CARDIAC EVENTS AND DECREASED HOSPITAL READMISSION RATES. SUMMARY

QUESTIONS/COMMENTS

REFERENCES