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Letter from our President, Cheryl Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN, Associate Professor, Johns Hopkins University

I appreciate the opportunity to reflect on my first year as president of the Preventive Cardiovascular Nurses Association (PCNA) and eagerly anticipate the progress we will see in the upcoming year. I am pleased to see that the PCNA continues to advance the role and recognition of nurses as local and global leaders in cardiovascular disease (CVD) and stroke prevention.

  
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In the past year, an update of the Cardiovascular Nursing: Scope and Standards of Practice was published.1 In this document, with PCNA representation, the workgroup delineated the following key elements of cardiovascular nursing: (1) development of programs that promote heart health; (2) education and counseling about heart health; (3) interventions that reduce risk factors; (4) individualized evidence-based interventions that maintain or improve physiologic, psychological, and psychosocial health; (5) interventions that facilitate and optimize behavioral change and treatment adherence over time; (6) conducting research; and (7) advocacy to support patients and families during the planning, implementation, and evaluation of their care. Excellence in cardiovascular nursing requires advanced cardiovascular knowledge and skills.

 

In recognition of the individual and collective contributions that nurses have made in CVD and stroke prevention and the promise of empowering nurses as global cardiovascular leaders, PCNA has established the Global Cardiovascular Nursing Leadership Forum (GCNLF).2 The GCNLF is designed to champion a global nursing movement for CVD and stroke prevention across the lifespan of individuals and families from both developed and developing countries. The GCNLF is promoting a master plan for international nursing organizations to identify and facilitate optimal ways in which nurses and nursing organizations can be more effective in CVD and stroke prevention worldwide. The long-term goals of this forum are to elevate the role of cardiovascular and stroke nursing globally and to affect CVD prevention and treatment around the world.

 

In addition, the evidence base for CVD and stroke prevention and care continues to rapidly evolve. The PCNA has contributed in important ways to the development and dissemination of numerous recent clinical guidelines. Furthermore, PCNA has recently focused strategic planning efforts on enhancing the content and delivery of our professional and continuing education and patient education. We will strive to build on our highly successful past efforts while identifying innovative new approaches that best meet the needs of our members and the broader CVD and stroke prevention professional community so they may successfully rise to the current care challenges.

 

Finally, PCNA will focus efforts over the next year on increasing opportunities for member engagement and leadership in our vibrant organization. Please take advantage of the numerous opportunities to enhance your cardiovascular nursing practice and leadership through our webinars, online education and clinical tools, regional and chapter meetings, and our annual symposium. I encourage you to increase your involvement in PCNA to share your knowledge, skills, and expertise with our community while you gain personally and professionally.

 

1. Handberg E, Arslanian-Engoren C, Baas L, et al. Cardiovascular Nursing: Scope and Standards of Practice. Silver Spring, MD: American Nurses Association; 2015. http://Nursesbooks.org.

 

2. Hayman LL, Berra K, Fletcher BJ, Houston Miller N. The role of nurses in promoting cardiovascular health worldwide: the Global Cardiovascular Nursing Leadership Forum. J Am Coll Cardiol. 2015;66(7):864-866.

 

 

Updated Patient Education Tools Released

PCNA is excited to announce the availability of one of our newly revised patient education sheets in both English and Spanish: What You Need to Know: Triglycerides and HDL. The PCNA continues to be active in evidence-based management of dyslipidemia, a risk factor for heart disease, through the development and distribution of a variety of plain language, culturally diverse education materials. We have already distributed more than 20 000 patient education sheets and are excited to share the newly revised sheets with our members and partner organizations. The project is supported by an independent educational grant from AstraZeneca.

 

The Get Tough on Angina patient education tools are some of PCNA's most popular titles. The trifold brochure (in English and Spanish) and 32-page booklet (in English) have been recently updated and are now available to PCNA members and related organizations. The project is supported by an educational grant from Gilead Sciences, Inc.

 

Rocky Mountain Chapter Journal Club Update

In 2015, the Rocky Mountain Chapter of PCNA took on the challenge of increasing engagement among members and nonmembers by piloting a journal club. Since its inception, there have been 3 sessions. The participant-selected session topics included "heart failure across the healthcare spectrum," "motivational interviewing," and "psychosocial influences on adherence." The planning of the events has become more streamlined in the processes of topic and article selection. The leadership committee has been able to review relevant and interesting articles, offering more depth and insight to the topic for the selection committee. For the January 2016 journal club event, we offered an educational review of how to critically evaluate research to enhance scholarly and professional conversations regarding the data and information presented in the session's selected articles.

 

Attendance has averaged 10 participants for each of the 3 journal club events. Participants are a mix of members and nonmembers, offering exposure and a taste of what PCNA can offer professionals in preventive cardiovascular care. We have noticed that each topic draws a new group of professionals, adding variety to interactions and variety to the discussion portions of the event. The leadership and planning committees have decided on a consistent location that is central, comfortable, and clean, all of which are crucial to recruiting participants. We are excited to continue to offer the journal club on a biannual basis to complement the Annual Symposium and enhance attendance for other chapter meetings.

 

The Rocky Mountain Chapter encompasses a large geographical area. To make the sessions more accessible, we have added the option to join the group remotely through telephone connection. We are also exploring video connection for future sessions to further enhance the experience for participants.

 

This endeavor has proven to be worthwhile and successful in meeting the objectives set forth in the initial proposal. The chapter leadership has decided to continue offering the journal club sessions and is grateful to the PCNA national office staff for the assistance they provide. If your chapter is interested in starting a journal club, please contact the PCNA national office.

 

Challenge Colleagues in May: Raise Stroke Awareness and Expertise

To celebrate American Stroke Month this May, we would like to highlight some valuable resources for stroke prevention and awareness.

 

The American Heart Association and American Stroke Association (AHA/ASA) have a "Spot a Stroke FAST" mobile app that features the FAST stroke warning signs: face drooping, arm weakness, speech difficulty, and time to call 911. This app guides users on stroke prevention, life after a stroke, nearby stroke centers, and has a link to Stroke Connection magazine available as digital and mobile editions.

 

The 2016 heart disease, stroke, and research statistics from AHA/ASA relay that stroke accounts for nearly 12% of deaths globally and is the leading cause of preventable disability. With a prevalence of 33 million stroke survivors worldwide, we can expect to care for many of these patients.

 

The good news is that the latest AHA/ASA stroke statements and guidelines are readily available to incorporate into professional practice and include the following:

 

* 2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment

 

* Guidelines for the Primary Prevention of Stroke (2014)

 

* Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack (2014)

 

* Guidelines for the Prevention of Stroke in Women (2014)

 

* Interactions Within Stroke Systems of Care: A Policy Statement From the AHA/ASA (2013)

 

 

Another resource is the National Institute of Health's online or mobile Stroke Scale training, with continuing education credit upon successful completion. Plus, be sure to access the ASA's "Stroke Resource Center" with downloadable education materials such as the "Stroke Discharge Checklist and Daily Home Care Guide."

 

For those with a history of stroke, there are some tailored resources in AHA/ASA Physical Activity and Exercise Recommendations for Stroke Survivors (2014). Exercise along the continuum of stroke care is profiled with an emphasis on use of adaptive machines, low- to moderate-intensity aerobic activity, and muscle strengthening. Challenges do abound for those patients who are more disabled, but barriers to physical activity are addressed, as well as ways to enhance motivation so this population can benefit from exercise as medicine and secondary prevention too!

 

Finally, advocacy for improved stroke systems of care is an opportunity in the United States. Efforts are underway to support the Furthering Access to Stroke Telemedicine Act so reimbursement for remote video or telestroke evaluation is not limited to patients in rural areas. The AHA/ASA You're the Cure advocacy center has more details.

 

Hypertension: What Do We Follow?

In 2014, the Eighth Joint National Committee (JNC 8) released new guidelines for hypertension. The recommendations from JNC 8 reflected higher blood pressure goals than the previous JNC 7 guidelines did. One of the strongest differences between JNC 8 and JNC 7 guidelines is the increase in the blood pressure goals for the elderly and those with diabetes and chronic kidney disease found in JNC 8 guidelines. Many studies have shown that lowering blood pressure significantly reduces the risk of stroke as well as related cardiovascular disease. For several reasons, the JNC 8 guidelines have been challenged by the cardiology community. A new hypertension writing committee has been formed by the AHA and the American College of Cardiology (ACC). This guideline will replace JNC 7, which is the most recent hypertension guideline that is endorsed by AHA and ACC. Nine other medical societies, including PCNA, have partnered with AHA and ACC to develop the guidelines.

 

The comparison of JNC 8 and JNC 7 follows: JNC 8 recommends blood pressure for the general population of older than 60 years old of less than 150/90 mm Hg; JNC 7 recommends less than 140/90 mm Hg. The JNC 8 recommends a goal less than 140/90 mm Hg in diabetic patients and patients with chronic kidney disease; JNC 7 recommends less than 130/80 mm Hg. for patients with diabetes and chronic kidney disease. The 2014 Guidelines for Stroke Prevention in Patients with Stroke and TIA rely on the JNC 7 recommendations.

 

Because May is Stroke Awareness month, the topic of hypertension is important as it is a major risk factor for stroke. Unfortunately, while optimal blood pressure targets are still debated, many patients are left with blood pressures poorly controlled. The AHA and ACC continue to endorse the JNC 7 guidelines while awaiting the new guidelines. They also suggest that the clinician look at the individual patient and assess for comorbid diseases in choosing treatment for the individual. In addition, as a clinician, look at the level of evidence to help guide your decision in the treatment of your patients. But do not forget to look at the lifestyle interventions that are helpful and a foundation in blood pressure control. The 2014 Stroke Prevention in Patients With Stroke and TIA Guidelines recommends reduction in dietary sodium to less than 2.4 g/d. They also recommend that further reduction below 1.5 g/d of dietary sodium is also reasonable for greater blood pressure lowering. A Mediterranean-type diet with an emphasis on vegetables and fruits is favored in the guidelines.