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PCNA News May-June 2020

The Journal of Cardiovascular Nursing: 5/6 2020 - Volume 35 - Issue 3 - p 223-224
doi: 10.1097/JCN.0000000000000697
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New and Updated Preventive Cardiovascular Nurses Association Tools

New Tool: Hereditary Amyloidosis

The Preventive Cardiovascular Nurses Association (PCNA) has developed a new tool to help healthcare providers and their patients identify the common signs and symptoms of hereditary transthyretin amyloidosis (hATTR) and its implications for the cardiovascular system. “Hereditary Amyloidosis: What You Need to Know” is a 2-page handout available in English and Spanish.

Awareness of hATTR is important as early detection is the key to optimal management. This tool defines hATTR, lists the signs and symptoms, and provides resources regarding genetic testing, treatments, and ongoing support. It is available as a free download and can also be ordered in sets of 25 sheets.

Updated: Stroke Prevention Guide

The PCNA's Stroke Prevention Guide is an electronic guide designed to help clinicians understand and apply guideline-directed prevention and treatment strategies. It includes a variety of tables, links, and printable PDFs to help you understand how to help reduce the risk of stroke for your patients.

The newest version of our Stroke Prevention Guide includes updates from the 2019 AHA/ACC/HRS AFib Guidelines and the 2018 Guidelines for Early Management of Acute Ischemic Stroke. We also incorporated updates from the 2019 Primary Prevention Guidelines and the 2018 Cholesterol Guidelines. Learn more at

Experiences in Advocacy With Emily Jones

Emily Jones, BSN, PhD, of Boston, Massachusetts, received PCNA's Advocacy Award for CVD Prevention in 2019. Here, she recounts her experiences and shares her advice for how to get started with advocacy.

Nurses advocate in myriad ways, seen and unseen. We advocate for individual patients, families, communities, groups with diverse health needs, and society's most vulnerable and marginalized. We advocate in clinics for the best plans of care. We advocate in communities for social justice and health equity. Our desire to support those for whom we care and promote their highest well-being is what keeps us learning, growing, and developing as human beings and nurses.

I am extremely honored to have received the 2019 PCNA Advocacy Award. My nursing career centers on advocacy for childbearing American Indian women's cardiometabolic health, and it began in the labor and delivery unit of a community hospital. I witnessed firsthand the gap that existed between women's obstetrical care and their primary or, as I like to call it, “rest of life” care, including prevention of cardiovascular disease and diabetes. The gap was particularly apparent for women with pregnancy complications such as gestational diabetes and hypertensive disorders. It was this lack of patient-centered, preventive follow-up care after pregnancy that prompted me to pursue my PhD and set a course to bridge that gap through research and practice.

During and after my doctoral coursework, I learned the value of listening to the stories of individuals with lived experiences very different than my own, and my eyes opened to the reality of health disparities. Furthermore, my mind opened to the possibility that I could collaborate with community partners as a nurse scientist to conduct research that would ultimately promote health equity for childbearing American Indian women (and their children and families) with a significant cardiometabolic risk. I realized that a community-engaged and driven research career would be a vessel to advocate for policies at all levels to promote health equity for American Indian women. Ultimately, I realized that my research, rooted in advocacy, would be my practice.

As a Robert Wood Johnson Foundation nurse faculty scholar (2014–2017), I received formal advocacy training in Washington, DC, and that experience boosted my confidence in reaching out to legislative staff and elected officials to voice concern and raise awareness around policies that impact women's health. In 2018, I was invited to participate in a convention of the National Heart, Lung, and Blood Institute and WomenHeart, the first and only national, patient-centered organization dedicated to serving women with heart disease. I attended as one of several researchers to represent partnerships with tribal communities focused on promoting indigenous women's cardiovascular health through research. I was profoundly grateful as I listened to older Native American women tell stories that reminded me why I advocate—women's hearts are sacred. They are the source of life and goodness in their families and communities.

I am currently involved in advocacy at the state level through the Diabetes Caucus of the Oklahoma State House of Representatives. Caucus members advocate for a variety of policies concerning diabetes care; I work with a subgroup that advocates for increased access and reimbursement for diabetes prevention programs and Medicaid expansion, particularly for high-risk groups such as postpartum women after gestational diabetes. I started attending the monthly Caucus meetings because my community partner co-investigator invited me to join her. This underscores one of my favorite aspects of advocacy—the process and results are optimized when we work in teams. If you have never personally been involved in advocacy-related work, reach out to a friend or colleague who is and join them in attending a policy-planning meeting or legislative visit. Get engaged. Listen. Ask questions. Offer your expertise. Use your voice. And then invite another nurse to join you.

Will the United Kingdom's Idea of Changing Food Labels Catch On?

The United Kingdom is considering a controversial move to use a symbol on food labels to indicate how much exercise (walking, running) is required to burn off 1 serving of that food.1 Both food and drinks are targeted. The idea is to keep the food part of the label (calories and nutrients) the same and add this exercise symbol, called physical activity calorie equivalent (PACE) labeling.1–4 Will more information on the food packaging, in the form of exercise advice, be better? What effect might PACE labeling have? The Royal Society of Public Health in the United Kingdom is in favor of the PACE labels. The hope is that the PACE labeling will impact the selection, purchase, and consumption of food.

Dr Amanda Daley2 reported that the current UK food labels have had a little impact on the persistent problem of obesity in the United Kingdom. Her team conducted a meta-analysis recently,2 reviewing 15 research studies on the effect of PACE labeling versus comparator labeling. They found that significantly fewer calories were selected and fewer calories were consumed in the PACE labeling group versus comparator food labeling or no labeling. Calorie reductions as low as 100 calories per day accompanied by sustained physical activity may reduce obesity.

Experts favoring PACE labeling see it as a simple strategy for labeling of food products by the manufacturer, on restaurant menus, and even on price lists under each item at supermarkets and warehouse food stores. However, several limitations of the research on PACE labeling exist including the use of small samples and the use of experimental settings, not real-life settings such as supermarkets.

Several experts have also spoken out about the possible detrimental influences of PACE labeling. For example, eating disorder experts point out that, for their patients experiencing or vulnerable to eating disorders and exercise addiction, encouraging exercise to match the calorie value of foods eaten might exacerbate these conditions.3,4 Advocates for patients with eating disorders see the labels as a so-called simplistic approach5 to a much bigger, more complex problem, one including obesity-shaming and major psychosocial influences. Their premise is that there needs to be more focus on confidence and support for healthy eating and less focus on weight and calories.4

The proposed exercise advice emphasizes burning calories and, in no way, provides messages as to whether the actual food product is healthy or not healthy.3 In addition, exercise scientists note that accurate estimation of calorie expenditure, in the form of numbers on a package, is more different than it seems on the surface. For example, it varies between children and adults, and it varies among individuals based on how much energy it takes for the body to produce heat.5 Finally, some experts are not convinced by the findings of the meta-analysis and see a big problem in that there is an absence of follow-up data on whether the PACE labeling influences physical activity habits over time.5

Cardiovascular nurses might consider whether PACE labeling would work in their own country. Whether PACE labeling would work best in their practice as part of individualized, tailored teaching sessions or at the population level would need to be determined.


1. Loughborough University. (2019). Press release: labeling foods with the amount of physical activity needed to burn off calories linked to healthier choices. Accessed March 31, 2020.
2. Daley AJ, McGee E, Bayliss S, et al. Effects of physical activity calorie equivalent food labelling to reduce food selection and consumption: systematic review and meta-analysis of randomised controlled studies. J Epidemiol Community Health. 2020;74(3):269–275. doi:10.1136/jech-2019-213216.
3. 62CBSDetroit. (2019). Press release: researchers: exercise advice on food labels could help reduce obesity. Accessed March 31, 2020.
4. Beat Eating Disorders. (2019) Beat's response to ‘exercise calorie’ labelling. Accessed March 31, 2020.
5. Mathews J, Sale C. (2019). Feel the (calorie) burn: can advice on food labels halt UK obesity?
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