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PCNA News

Walter, Katy, BS

Journal of Cardiovascular Nursing: March/April 2019 - Volume 34 - Issue 2 - p 99–102
doi: 10.1097/JCN.0000000000000564
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The 25th Annual Cardiovascular Nursing Symposium

The Preventive Cardiovascular Nurses Association's 25th Annual Cardiovascular Nursing Symposium will continue our tradition of combining clinically relevant content presented by world-renowned and regional experts in an intimate setting that allows you to connect with colleagues and nurse leaders and return to your practice rejuvenated and energized.

  • Earn 14.75 CE contact hours, including 5.1 pharmacology
  • Hear the latest in cardiovascular nursing practice in one place—with relevance to the bedside, clinic, and community
  • Take a step back and revisit the why and how of what you do every day
  • Most meal events are included in the cost of registration.
  • Have a particularly challenging case or problem? Talk to nursing leaders and colleagues to help you problem-solve.

Spend your continuing education dollars with a mission-based organization that works to promote nurses as leaders in cardiovascular disease (CVD) prevention and management.

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Featured Speakers

Sharonne N. Hayes, MD, founder of the Women's Heart Clinic at Mayo Clinic in Rochester, Minnesota, will discuss “Women and CVD: Creating Awareness and Making Prevention a Priority” during her opening keynote session on Friday, April 12, at 9:15 AM. Dr Hayes has had a long-standing interest in sex- and gender-based cardiology and caring for a wide variety of cardiovascular conditions that occur primarily and/or differently in women spanning prevention, diagnosis, and treatments across women's life spans. She helped to launch the Women Heart Science and Leadership Symposium at Mayo Clinic, aimed at preparing women with heart disease from around the country to be community educators, advocates, spokespersons, and support network coordinators.

Dr Hayes has a special interest in achieving health equity among diverse populations, including women, racial and ethnic minorities, sexual minorities, and others who experience health disparities. In addition to her clinical and research activities, Dr Hayes serves as Mayo Clinic's Director of Diversity and Inclusion and is responsible for developing solutions for improving cultural competence and equity in patient care and the workforce.

Diane Treat-Jacobsen, PhD, RN, is a leading advocate for increasing the awareness of peripheral arterial disease (PAD) through screening, early detection, and management. A professor in the School of Nursing at the University of Minnesota, Dr Treat-Jacobson has directed a 3-year initiative to build awareness and increase screening and treatment of PAD in Minnesota. Through this initiative, hundreds of residents in rural Minnesota were screened for PAD by healthcare providers trained by Treat-Jacobson to perform an Ankle Brachial Index, which uses a handheld Doppler device to measure blood pressure in the ankle and compare it with blood pressure in the arm. Creating awareness and identifying individuals with PAD not only allow for early treatment of this progressive and debilitating disease, it also identifies those at a high risk for heart attack or stroke. Dr Treat-Jacobson's research interests also include quality of life and exercise training in patients with claudication from PAD. She will share this expertise on Saturday, April 11, during her keynote address, “Lower Extremity PAD: How to Help Your Patients Get Back on their Feet.”

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Another Round of Evidence for Physical Activity in Cardiovascular Disease Prevention

Cardiovascular nurses approach risk reduction and prevention from a risk assessment and health promotion framework. One of the major modifiable risk factors for CVD is physical inactivity. Although physical activity promotion is a key component of CVD nursing practice and research for both primary and secondary prevention, recent reports and guidelines add emphasis to the importance of addressing this CVD risk factor. These include a recently published review of studies on physical activity, primary prevention, and secondary prevention.1 In addition, updated US Physical Activity Guidelines,2 submitted to the Secretary of Health and Human Services in February 2018 and published in JAMA in November 2018, add depth and breadth to recommendations for Americans for improving health through physical activity.

Fletcher and colleagues1 reviewed studies examining the role of physical activity for primary and secondary prevention of CVD. They concluded that all forms of physical activity have a beneficial effect on primary CVD prevention regardless of age, sex, or ethnicity. Furthermore, both the intensity and duration of physical activity were directly related to improved outcomes. They found that physical activity also reduces recurrent CVD events from a secondary prevention perspective. Cardiac rehabilitation for CVD, heart failure, and PAD was supported for its beneficial effects on reducing mortality and morbidity in those with these conditions. They concluded that the recommendation of 30 to 60 minutes of moderate-intensity aerobic physical activity at least 5 days and preferably 7 days a week supplemented by leisure and lifestyle activities such as recreation, gardening, and household work is solidly grounded in the available published science.

The authors also note that physical inactivity and sedentary behavior are highly prevalent and account for around 54.9% or 7.7 hours of awake time per day. The serious health effects of physical inactivity have been noted to include an increased risk for CVD as well as other chronic conditions.

The 2018 Physical Activity Guidelines Advisory Committee also conducted a systematic review of the science supporting the relationship between physical activity and health.2 They note that 80% of US adults and adolescents do not get enough physical activity. The guidelines recommend that adults get at least 150 to 300 minutes a week of moderate-intensity or 75–150 minutes a week of vigorous-intensity aerobic physical activity or an equivalent combination of the two. Muscle strengthening activities (eg, weight lifting or resistance training) are also recommended for 2 or more days each week. These recommendations are designed to promote improved bone health, maintain weight, promote cognitive function and brain health benefits, reduce anxiety and depression, improve sleep, reduce the risk of all-cause and disease-specific mortality, improve physical and overall function, and improve quality of life. Adults with chronic conditions or disability are recommended to also follow the guidelines, including strengthening and aerobic physical activity, to the degree possible.

What types of physical activity are in these categories? Most categorizations define moderate-intensity activities equivalent to brisk walking, whereas vigorous-intensity activities include running and jogging.

What is new in this report? Important for initiating physical activity plans for someone who is primarily sedentary is the optimistic outcome from the data review that suggested that, although more activity has better outcomes, even a small amount of activity is beneficial. Previous guidelines suggested that episodes of physical activity last for at least 10 minutes. However, the new guidelines suggest that even a 2-minute increment of activity counts toward the total, which could be viewed as more achievable by a sedentary patient, rather than starting with the weekly goal. Overall, the guidelines stress that moving more and sitting less will benefit all population groups.

These 2 reviews reinforce the guidelines that preventative cardiovascular nurses can use when providing education and counseling to adults for the prevention of CVD and to improve outcomes in those with CVD.

  1. Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ. Promoting physical activity and exercise. J Am Coll Cardiol. 2018. doi:10.1016/j.jacc.2018.08.2141.
  2. Piercy, KL, Troiano, RP, Ballard RM, et al. The 2018 Physical Activity Guidelines Advisory Committee scientific report. JAMA. 2018;320(19).
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What's New in Nutrition: The “PURE DIET”

News has reached the lay public about a nutritional approach called the “PURE diet,” which has been a source of confusion and controversy over the last year. What was the study about, and what makes understanding the findings of the study so challenging?

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The Study

The Prospective Urban Rural Epidemiology (PURE) investigators conducted a large prospective cohort study on 135 335 adults (aged 35–70 years) from 18 countries on 5 continents enrolled from 2003 to 2013, with an average follow-up of about 7.4 years.1 Validated food frequency questionnaires were used to record dietary intake. Food intake (protein, fat, and carbohydrate) was categorized, and percentage of energy from nutrients was analyzed. Primary outcomes were total mortality and cardiovascular events such as heart failure, stroke, fatal CVD, and nonfatal myocardial infarction.1 The research found that a high carbohydrate intake (providing >60% of energy) was associated with an adverse impact on total mortality and on non-CVD mortality. In addition, they found that higher fat intake was associated with a lower risk of total and non-CVD mortality as well as stroke. 1 The researchers summarized that the findings of the PURE study do not support current clinical dietary recommendations to reduce total fat intake to less than 30% or current guidelines on saturated fats.

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The Challenges

Many headlines portrayed the PURE study as the PURE DIET, yet the researchers more generally studied food intake in 18 countries. This attention to naming the study as a diet may have occurred because Americans are used to hearing about the latest new “diet.” However, this approach confuses the lay public. A particularly emphatic Internet headline reads, “A low-fat diet might kill us, finds the new PURE study.”2 Preventive cardiology nurses must continue to help patients understand information about nutrition and prevention. Importantly, much discussion must occur between researchers and clinicians to determine how applicable the findings are to prevention in the United States.

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Many Specific Unanswered Questions Remain About the Findings According to an Article in Lancet3

Further analysis by the PURE study investigators is needed to evaluate whether meats and dairy reduce mortality. To do this, the relationship of specific animal products3 to mortality must be determined.

The fact that some countries studied might have both micronutrient-poor carbohydrates and micronutrient-rich meats3 may be a confounder in carbohydrate versus fat comparisons in these countries' results. The PURE study group will need to sort out this possible intervening micronutrient variable.

The role of high carbohydrates in mortality is not clear.3 Clarification is needed about the associations between whole and refined grains, added sugars, and mortality.

The PURE study is not a randomized trial, and it has questioned long-held tenets regarding what constitutes a healthy diet for cardiovascular prevention.3 Further research, in the form of well-controlled randomized trials, is needed to explore causal relationships between dietary fat content and health outcomes before cardiovascular nurses implement its findings in practice.

  1. Dehghan M, Mente A, Zhang X, et al. (2017) Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 390:2050–2062. doi:10.1016/S0140-6736(17)32252-3
  2. Eenfeldt A. A low-fat diet might kill you, finds the new PURE study. https://www.dietdoctor.com/low-fat-diet-might-kill-finds-new-pure-study. Accessed August 31, 2017
  3. Ramsden CE, Domenichiello AF. (2017) PURE study challenges the definition of a healthy diet: but key question remain. Lancet. 390:2018-2019. https://www.thelancet.com/journals/lancet/article/PIIS0140-67361732241-9/fulltext
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Churches as Influential Institutions for Health Promotion

Several studies in the literature cite churches as influential institutions for health promotion in black communities.1–3 A recent study reported in Circulation compared the effectiveness of a therapeutic lifestyle change plus motivational interviewing intervention versus health education alone for improving hypertension management.4 The FAITH study (Faith-Based Approaches in the Treatment of Hypertension) is the first community-based program to implement a lifestyle intervention for systolic blood pressure reduction delivered by lay health advisors in churches.4

The FAITH trial differs from similar studies in that it included a control group and a rigorous assessment of blood pressure outcomes. It was a 2-arm randomized controlled trial that tested the hypothesis that participants in the churches randomized to the motivational interviewing–therapeutic lifestyle change group would have greater reduction in mean arterial pressure, systolic blood pressure, and diastolic blood pressure at 6 months and better blood pressure control at 9 months than those in churches randomized to the health education group. The trial was conducted in 32 black churches in New York City. Participants were identified at the churches through responses to presentations, posting of flyers, face-to-face recruitment, and endorsement from the pastors from the pulpit.

The motivational interviewing–therapeutic lifestyle change group consisted of eleven 90-minute weekly group sessions focused on healthy lifestyle behaviors such as consuming a low-fat and low-sodium diet rich in vegetables and fruits, weight loss, and increasing physical activity. The group was given information on meal planning, stress management, medication adherence, goal setting, and tasting healthy foods. They were encouraged to keep food and exercise diaries. All instructions included elements of prayer, scripture, and faith-based discussion. The group sessions were followed by 3 individual motivational interviewing sessions to help participants with problem solving and maintaining lifestyle changes. Lay health advisors were recruited at the churches and trained to deliver the intervention.

The health education group served as the control group and received 1 lifestyle session on blood pressure management plus 10 informational sessions led by health experts on health education topics. The information sessions focused on lifestyle behaviors and hypertensive drug management. Participants also received the National Institute of Health booklet “Your Guide to Lowering Blood Pressure.” The health experts presented on additional topics such as fire safety, substance abuse, Alzheimer disease, and environmental health.

Although improvement was observed in both arms, the study demonstrated that a comprehensive faith-based lifestyle intervention plus motivational interviewing, led by lay heart advisors in churches, was associated with significantly greater reduction in systolic blood pressure when compared with health education among blacks with uncontrolled hypertension. Average systolic blood pressure reduction at 6 months was 16.53 mm Hg in the motivational interviewing–therapeutic lifestyle change group and 10.74 mm Hg in the health education group. At 9 months, the motivational interviewing–therapeutic lifestyle change group showed a 18.2-mm Hg reduction in systolic blood pressure, whereas the health education group reduced 13.0 mm Hg.

This study is also important from a policy perspective because it focuses on the use of community health workers and lay health advisors as an effective means for implementing evidence-based public health practices in community settings. The low cost and the potential for sustainability are 2 positive features of this model.5 According to the Centers for Disease Control and Prevention, this model is associated with effective communication of health messages in “culturally salient ways.”6

  1. National High Blood Pressure Education Program. Churches as an Avenue to High Blood Pressure Control. Bethesda, MD: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program; 1987.
  2. Wimberly AES. The role of black faith communities in fostering health. In: Taylor SE, Braithwaite RL, eds. Health Issues in the Black Community. 2nd ed. San Francisco, CA: Jossey-Bass; 2001:129–150.
  3. Peterson J, Atwood JR, Yates B. Key elements for church-based health promotion programs: outcome-based literature review. Public Health Nurs. 2002;19:401–411.
  4. Circ Cardiovasc Qual Outcomes. 2018;11:e004691. doi:10.1161/CIRCOUTCOMES.118.004691
  5. Institute of Medicine (US) Committee on Public Health Priorities to Reduce and Control Hypertension. A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. Washington, DC: National Academies Press (US); 2010.
  6. Centers for Disease Control and Prevention (CDC). CDC's Division of Diabetes Translation Community Health Workers/Promotores de Salud: Critical Connections in Communities. https://www.cdc.gov/diabetes/projects/pdfs/comm.pdf.
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The Global Cardiovascular Nursing Leadership Forum Convenes in Lisbon

Nurse leaders from around the globe gathered in Lisbon, Portugal, in the fall of 2018 to tackle the global epidemic of CVD. Although CVD and stroke are largely preventable, they remain a global epidemic and the major cause of death worldwide.

Recognizing that nurses are on the front lines of this epidemic, the Preventive Cardiovascular Nurses Association formed the Global Cardiovascular Nursing Leadership Forum, whose mission is to engage and mobilize nurse leaders to promote the prevention of CVD and stroke worldwide through research, education, policy, and advocacy.

Twenty attendees representing 15 countries built on progress achieved since the inaugural 2014 meeting in New York and the second meeting in Barcelona, Spain, in 2016. The group strategized on how to continue to build capacity by expanding our global association liaison network and discussed the deployment of an International Cardiovascular Nurse Certificate.

Learn more about the Global Cardiovascular Nursing Leadership Forum at GCNLF.org.

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