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Preventive Cardiovascular Nurses Association News

The Journal of Cardiovascular Nursing: November/December 2016 - Volume 31 - Issue 6 - p 479–482
doi: 10.1097/JCN.0000000000000373
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Denver Is the Place to Be for the Preventive Cardiovascular Nurses Association 23rd Annual Symposium on Cardiovascular Nursing

Registration for the 2017 Annual Symposium on Cardiovascular Nursing is now open! Join us at the Marriott Tech Center in Denver, Colorado, on April 6 to 9, 2017, for the cardiovascular nursing conference of the year.

Topics for this year’s symposium include the following:

  • A Call to Action: Population Health and CVD Prevention
  • CVD Risk Assessment and Health in Women Across the Lifespan
  • Obesity and Health Behaviors: Success Stories From the National Weight Control Registry
  • Pharmacological and Surgical Management for Weight Loss
  • Million Hearts in 2017: The 5-Year Challenge to Prevent Heart Attack and Stroke
  • Physical Activity: The Magic Bullet
  • Making the Head, Heart and Vascular Link: CVD Risk Factors and Dementia
  • Cardio-Metabolic Risk Management: Promoting Health and Preventing Disease
  • Healthy Aging: Improving Quality of Life in Older Adults with Diabetes and Chronic Disease: A Joint Session of the AHA CV Nursing Council and PCNA
  • Prevention and Management of Stroke Across the Continuum of Care
  • Skill-Building Sessions
    • ○ Effective Strategies for Engaging Patients in Health Behavior Change
    • ○ Chest Pain! How to Perform a Comprehensive Evaluation for Ischemia
  • Breakout Sessions
    • ○ Interpreting and Translating Research Into Practice
    • ○ Structural Health Interventions: Valve, Clips, and Plugs, Oh My!
    • ○ Health Effects of Marijuana, E-Cigarettes, and Vaping

Thursday, April 6, will feature the third annual Pharmacology Preconference. Participants can earn continuing education credits while learning the latest in preventive cardiology and networking with colleagues in the field. Topics for the Pharmacology Preconference include the following:

  • Cardio-Metabolic Risk Reduction in Patients With Pre-Diabetes and DM2
  • It’s a Balancing Act: Medication Management of Patients with Chronic Kidney and Cardiovascular Disease
  • Pharmacological Management of the Cardiac Patient With Depression and/or Anxiety

Registration is now open at pcna.net/symposium. Register before March 2017 to receive the early bird discount.

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Veterans and Diabetes

National Diabetes Month is observed every November to draw attention to diabetes and its effects on millions of Americans. Most know that Veteran’s Day is also in November, but did you know that 24% of men and women who served our country have diabetes? That is much higher than the 9% of all Americans who have diabetes.

According to Forecast Diabetes Magazine, there are several theories as to why diabetes disproportionately affects veterans. One is that veterans are overweight and obese at higher rates than the general population. Another is that Veterans Administration (VA) patients tend to be older, have lower incomes, and have limited access to high-quality, healthy food. These social disparities can lead to greater diabetes risk. The VA has also been studying suspected links between type 2 diabetes and herbicides like Agent Orange, which was used during warfare by US troops in the Vietnam War. Other aspects of war, such as trauma or injury to the pancreas which damages beta cells, have been linked to veterans developing type 1 diabetes.

There are nearly 23 million veterans currently live in the United States, and 9 million are enrolled in the Veterans Health Administration (VHA), with about 6.5 million seen each year. The VA provides medical facilities across the country to care for veterans, as well as education and other benefit programs that touch nearly every American family. The VHA is the largest healthcare system in the country. Comprehensive lifestyle management programs were initiated in the system more than 10 years ago and focus on prevention and management of type 2 diabetes. These programs are based on the results of the Diabetes Prevention Program, which demonstrated the effectiveness of making lifestyle changes to delay or prevent the onset of type 2 diabetes. The programs are tailored to meet the needs of those veterans already diagnosed with diabetes.

There are many levels of medical coverage through the VHA, and each veteran differs in terms of eligibility and benefits. In general, if diagnosed with diabetes while on active duty, a veteran’s diabetes supplies are a covered benefit. In the event a veteran is diagnosed after leaving active duty and that diagnosis is not related to active service, diabetes testing supplies are paid out of pocket. As in the private sector, VHA healthcare providers are responsible for treating the whole patient. The primary care providers are responsible for the general overall management of the patient, day-to-day management of their conditions, and preventive services. Referrals are made to specialists and social services as needed.

The VA has 3 missions: patient care, training healthcare professionals, and health research. The VA has led the charge in diabetes research. The VHA Diabetes Guidelines, first issued in 1997 and updated in 2010, and the Veterans Affairs Diabetes Trial are often cited alongside the ACCORD (Action to Control Cardiovascular Risk in Diabetes) and ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) trials as important in making headway in understanding diabetes care and preventing complications.

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New Advances in Diabetes Technology

Advances in technology in diabetes care were the focus of the American Diabetes Association’s 2016 Venture to Stop Diabetes Challenge. A device that fits on the back of a cell phone that enables people with diabetes to conveniently and discreetly check their blood glucose levels won the award. Pops Diabetes Care, Inc, developed the prototype and was awarded the grand prize of $10 000. The chief executive officer, Lonny Stormo, has type 1 diabetes and felt frustrated by the limitations of tools and technology in blood glucose testing, motivating him to seek a solution.

Stormo and his team developed a portable device, roughly the size of a pack of gum, that fits on the back of a smartphone. It includes 3 tiny lancets and 3 test strips that do not need to be removed from the pack. The process includes pricking a finger, dabbing the blood, and allowing the integrated meter to calculate your glucose level. Results are wirelessly uploaded to an app to make them available to family members and caregivers. The app also trends glucose levels, which may help people identify problems and make changes accordingly. Stormo says the results are quick, less painful, and discreet and there are no test kits with several pieces to carry, which, he pointed out, do not fit in running shorts.

The app is user friendly, and unlike others that simply track carbohydrates, calories, and activity levels, it can also be tailored to individual age groups. Children can earn points and badges for healthy behaviors the lead to good A1C levels. Teenagers can set up social groups to challenge each other to reach desired results and to share positive news. Stormo’s goal is for the app to be like a personal friend. It adapts to the individual, addressing the user like a friend would, providing encouragement, and challenging users to reach new levels of achievement.

The Venture to Stop Diabetes Challenge was held at the American Diabetes Association EXPO in Chicago in April of this year. Contestants in the competition were judged on relevance, creativity and innovation, feasibility and sustainability, and organization and clarity. Stormo, along with other finalists, pitched their products to a panel of judges. His device won based on its potential appeal to kids, as well as the convenience and unobtrusive way to carry and use it with a cell phone.

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Hospice-Palliative Care: When to Refer for End-Stage Cardiac Patients

We often think of hospice and palliative care for those with cancer. But any terminal illness with a life expectancy of 6 months or less qualifies, including end-stage cardiac patients. The American College of Cardiology (ACC) and the American Heart Association (AHA), as well as the Heart Failure Society, have recommended incorporating palliative care for advanced heart failure.

Because heart failure has remissions and exacerbations, it is more difficult to write evidence-based guidelines for admission to hospice. Heart failure patients experience dyspnea and fatigue as well as anxiety, depression, and generalized pain. In addition, the choice of medications for treatment may be more of a challenge. It is more difficult to identify medications that are curative versus palliative in heart failure. As an example, inotropes may be looked at by insurance companies as curative, when they can be used to decrease symptoms and improve comfort for heart failure patients.

The ACC provided the following recommendations for palliative care.1

  1. Timing of referral—When patient develops New York Heart Association class III or IV symptoms or ACC/AHA Stage D disease.
  2. Prognosis and disease trajectory—Prognosis with advanced heart failure can be quite variable, with many patients living beyond 1 year and illness trajectory marked by exacerbations and remissions.
  3. Care settings
    • Palliative care clinic, home care, and inpatient palliative care consults, as well as palliative care in skilled nursing facilities, since many patients lose functional decline early and lose the ability to live at home.
    • Hospice care when patients decide to forego readmission; many patients live for longer than 6 months on hospice and need to be recertified.
  4. Medications and therapies—Many therapies are continued throughout the course of illness as they continue to impact quality of life even if they no longer impact quantity of life.
  5. Role of caregiver burden and psychosocial stressors
    • Patients require more caregiver support for a longer period because of early loss of functional status and inability to continue working, often well before patients and caregivers can benefit from the support provided by the hospice benefit.
    • Psychosocial support must be outside the standard benefit structure in the form of innovative community-based programs funded by payers and providers.

Factors that suggest an increased likelihood of death and, thus, the possibility of hospice referral include the following:

  1. Frequent emergency department visits or hospitalizations
  2. Symptoms at rest
  3. Dependency in activities of daily living
  4. Weight loss greater than 10%
  5. Albumin level less than 2.5 g/dL
  6. Ejection fraction less than 20%
  7. Symptomatic arrhythmia
  8. Previous cardiopulmonary resuscitation
  9. Previous syncope
  10. Embolic stroke2
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Finding the Right Words to Promote Heart Health

October is National Health Literacy Month, which brings a renewed focus on our attempt to help our patients better understand what they need to know to improve their heart health.

Health literacy is defined by the Patient Protection and Affordable Care Act of 2010 as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Low health literacy is common among our patients regardless of their age, race, and cultural and socioeconomic background. According to the National Assessment of Adult Literacy, nearly 9 of 10 adults lack the skills needed to manage their health and prevent disease. Even those with high normal literacy skills can have low health literacy as a result of medications, illness, anxiety or fear impacting their attention and cognition.

The Preventive Cardiovascular Nurses Association has adopted the use of plain language in developing its patient education materials. Plain language is a strategy for making written and oral information easier to understand. It is an important tool for improving health literacy. Key elements for plain language include the following:

  • Organizing information so that the most important points come first
  • Breaking complex information into understandable chunks
  • Limiting the use of dense text; building in visual “white space”
  • Using everyday words and defining technical terms
  • Writing short sentences
  • Using the active voice

Visuals, such as pictures, drawings, charts, graphs, and diagrams, can be effective tools for communicating health information. They also help to make written educational pieces more attractive and can help with comprehension and reinforcement of written and spoken health messages. Be sure to provide clear headings, labels, and captions when using visual images to ensure that they are helpful and not confusing to low literacy individuals.

Language that is plain to one set of readers may not be plain to others. It is important to test any written materials used in clinical settings by having representative patients and/or family members review the piece and provide feedback. Plain language can and should also be applied to speech. Many plain language techniques apply to verbal messages, such as avoiding medical jargon and taking the time to explain technical or medical terms as simply as possible.

The Centers for Disease Control provides a wealth of health literacy resources on its Web site, www.cdc.gov/healthliteracy/. One of their key recommendations, and a good “take away” message, is to use “The Three A’s.” According to the Three A’s, health information should be

  • Accurate: using health literacy best practices does not mean distorting the science. Information needs to be easy to understand and accurate.
  • Accessible: make sure the information is in a place where people can see it; even in the digital age, Web-based information is not always the best way to reach our patients. Multiple channels and formats are best.
  • Actionable: we want to tell our patients everything we know about something, but that does not necessarily help! We typically want patients to start or stop doing something, or do more or less of something. Although some background information may be helpful, be sure you provide actionable information so that the people you want to reach can do something with the information provided.
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REFERENCES

1. Teuteberg JJ, Teuteberg WG. Palliative care for patients with heart failure. American College of Cardiology Web site. February 11, 2016. http://www.acc.org/latest-in-cardiology/articles/2016/02/11/08/02/palliative-care-for-patients-with-heart-failure. Accessed August 2, 2016.
2. Adler ED, Goldfinger JZ, Kalman J, et al. Palliative care in the treatment of advanced heart failure. Circulation. 2009;120:2597–2606.
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