The mission of the Preventive Cardiovascular Nurses Association (PCNA) is to promote nurses as leaders in cardiovascular disease prevention and management across the lifespan. The PCNA Advocacy Committee is in alignment with this mission to increase public and political awareness of the critical role that nurses play in comprehensive cardiovascular risk reduction across the lifespan. Throughout 2019, our committee supported numerous advocacy efforts with potential for positive impact on regional and national levels. We engaged our membership and partnered with many other like-minded organizations including the American Heart Association and the Society of Behavioral Medicine to support advocacy efforts aimed at implementing insurance coverage of important cardiovascular care such as ambulatory blood pressure monitoring, coronary artery calcium scoring, and reimbursement for health promotion referrals. We also joined with other major nursing organizations to support the National Nurse Act of 2019 (HR 1597), sponsored by registered nurse Congresswoman Eddie Johnson from the 30th Congressional District of Texas. This bill designates the Chief Nurse Officer of the US Public Health Service as the “National Nurse for Public Health” to serve alongside the US Surgeon General in identifying and prioritizing national health priorities.
In addition to the year-round advocacy work of PCNA and the Advocacy Committee, the Annual Symposium provides us with an opportunity to highlight a main policy issue. Our focus for the 2019 PCNA Annual Symposium was to garner support from attendees and all members to advocate for the “Increasing Access to Quality Cardiac Rehabilitation Act of 2019,” which was introduced into the House of Representatives on July 23, 2019, sponsored by John Lewis (D-GA) and Adrian Smith (R-NE) and introduced into the Senate on November 15, 2019, by Shelley Moore Capito (R-WV) and Amy Klobuchar (D-MN). This bipartisan legislation is designed to expand upon provisions made by Congress in 2018 to increase patient access to critically important cardiovascular services. In 2018, Congress included provisions in the Bipartisan Budget Act that authorized physician assistants and advanced practice nurses (nurse practitioners and clinical nurse specialists), referred to as advanced practice providers (APPs), to supervise patients' day-to-day cardiac and pulmonary rehabilitation care (CR/PR) beginning in 2024. This resolution would allow APPs to initiate that supervision in 2020, rather than 2024, which would increase access to care, particularly in rural and medically underserved communities. In addition, this legislation would allow APPs to order or refer patients to CR/PR under Medicare, which currently only allows physician authorization for such referrals.
Nearly 16.5 million Americans 20 years or older have coronary heart disease, and it is estimated that, in the year 2018, roughly 720 000 Americans would have had a new coronary event (defined as first hospitalized myocardial infarction or coronary heart disease death) and another 335 000 would have had a recurrent event.1 Cardiac and pulmonary rehabilitation are medically directed and supervised programs that include exercise training, education on heart-healthy living, behavior modification, and counseling. For patients with cardiovascular disease, CR programs are proven to reduce the risk of a future cardiac event, reduce cardiovascular-related mortality by 26%, decrease hospitalizations and the use of medical resources, and improve health-related quality of life.2 Similarly, for patients with chronic obstructive pulmonary disease, PR programs yield impressive results for improved health-related quality of life.3
Unfortunately, CR/PR remain underused, particularly among women, minorities, Medicare beneficiaries, and those in rural and underserved areas.4–6 Although the physician supervision requirement has been removed, allowing APPs to order CR/PR would expand access to these services in rural and underserved areas and among Medicare beneficiaries. Allowing only physicians to refer patients to CR/PR creates obstacles, delaying care that is needed in a timely manner. Advanced practice providers often serve as primary care providers for patients and are the providers most familiar with the needs of their patients. This legislation provides a common-sense improvement to CR and PR administration and services. Advanced practice providers are routinely on the front line in critical care environments such as hospitals and hospital clinics, emergency rooms, and intensive care units. They are highly trained to respond should emergencies arise, making it reasonable and appropriate to allow qualified APPs to order and supervise these safe and effective services. We encourage cardiovascular nurses to continue advocacy efforts in this area.
Furthermore, as we look ahead to 2020, a Presidential election year, it is ever more critical for cardiovascular nurses to be engaged in policy and advocacy initiatives. The issues highlighted and supported for 2019 will continue to need ongoing advocacy while 2020 is sure to present new and challenging issues, such as continuing to address access to care, funding for research, policy focused on healthy equity, and the escalating vaping crisis. The PCNA Advocacy Committee looks forward to our continued partnership with our membership and other like-minded organizations to support the evidence required to create sound policy and the advocacy needed to ensure appropriate implementation.
The authors thank Katy Walter, PCNA Communications Specialist, for her contribution in organizing PCNA Advocacy Committee meetings and leading the administrative component of the advocacy work we do.
1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation
2. Anderson L, Thompson DR, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev
3. Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev
4. Pack QR, Priya A, Lagu T, et al. Cardiac rehabilitation utilization during an acute cardiac hospitalization: a national sample. J Cardiopulm Rehabil Prev
5. Supervia M, Medina-Inojosa JR, Yeung C, et al. Cardiac rehabilitation for women: a systematic review of barriers and solutions. Mayo Clin Proc
6. Field PE, Franklin RC, Barker RN, Ring I, Leggat PA. Cardiac rehabilitation services for people in rural and remote areas: an integrative literature review. Rural Remote Health