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Message from the President -Laura L. Hayman, PhD, RN, FAAN

As the Preventive Cardiovascular Nurses Association (PCNA) begins its 14th year, membership approximates 2,000 nurses and other healthcare professionals from Canada, South America, Asia, Australia, Europe, and most states within the United States. From its inception, the major mission of PCNA has been to promote nurses as leaders in the prevention of cardiovascular disease (CVD), including comprehensive (global) risk assessment and reduction and disease management.


The 12th National Symposium, "Cardiovascular Risk Reduction: Leading the Way in Prevention," celebrated the mission of PCNA with state-of-the-science programming, including lectures, breakout sessions, and preconference workshops. Held in Denver, CO, the 2006 Symposium included approximately 700 attendees and 50 exhibitors and featured 3 days of substantive content emphasizing assessment, prevention, and management of CVD across the life span of individuals and diverse populations. Symposium speakers included internationally recognized experts in their respective fields who provided both the science base and new assessment and treatment methods for dyslipidemia, hypertension, diabetes, metabolic syndrome, and peripheral vascular disease. Thirty poster presentations, selected from abstracts submitted by attendees and featuring databased research and innovative clinical initiatives in the prevention and management of CVD, added uniquely to the 2006 Symposium.


PCNA's emphasis on evidence-based practice, including translating and applying current guidelines in primary and secondary prevention of CVD, was a cross-cutting theme. Highly relevant to this theme was a breakout session with content on understanding statistics and using research in practice and a general session on skill sets for behavioral change. Central to the mission and goals of PCNA, and well-received by all in attendance, this content will continue to be featured in future National Symposia.


Other sessions featured highly informative, state-of-the-science presentations on the genetics and the future of CVD prevention and the global burden of CVD. In addition, and in response to members' requests, content on innovative approaches for stroke prevention was included. A preconference workshop featured basic clinical and business skills for risk-reduction programs, including key operational considerations for clinically successful programs and the pivotal role of nurses in managing dyslipidemia and hypertension.


A new initiative central to our mission and goals, the PCNA Leadership Institute, was successfully launched as part of our 2006 Symposium. We were honored to have Martha N. Hill, Dean and Professor of the School of Nursing at Johns Hopkins University, present a dynamic keynote address, "Navigating the Leadership Path." Board members participated and addressed content central to leadership development in cardiovascular nursing and to leadership opportunities within PCNA. Finally, we were motivated and inspired by our closing keynote address, "Causing the Miraculous," dynamically delivered by Janet Lapp, creator of the award-winning CBS series "Keep Well."


During the next year, PCNA will continue with goals and activities focused on promoting nurses as leaders in the prevention and optimal management of CVD. Building on past accomplishments and current initiatives, key areas of emphasis will include the following: (1) providing members with evidence-based resources and tools necessary for the practice of prevention across healthcare and community-based and academic settings; (2) investing in our liaison relationships and partnerships with organizations and associations that share our mission and vision; and (3) developing and implementing strategic initiatives in our international outreach efforts.


I look forward, with the highest level of enthusiasm, to working with all of you (members and potential members) and our colleagues from other disciplines and organizations in advancing the mission and ultimate goal of PCNA: Cardiovascular health for all!

Figure. James Hill, ... - Click to enlarge in new windowFigure. James Hill, PhD, opens the Thursday (April 20) General Sessions Obesity Segment with a talk entitled "The Obesity Epidemic and Role of Modifiable Behaviors and Environments."

Preventive Cardiovascular Nurses Association Celebrates its 12th National Symposium

PCNA's 12th National Symposium, held in Denver from April 20 to 22, 2006, provided just the right combination of science and evidenced-based guidelines, clinical approaches to complex risk reduction and disease management scenarios, new methods for early identification of risk, lessons learned from chronic care programs, and new interventions for a variety of cardiovascular diseases (CVDs). Interwoven throughout the main arena presentations were a preconference, leadership institute, variety of breakout sessions, breakfast and dinner sponsored programs, poster presentations, lipid testing opportunities, and an easy-to-navigate exhibit hall. Highlights from just a few parts of the program are presented below.


The Obesity Segment

Four experts combined talents to present an afternoon program covering the complete range of obesity-related topics. Dr James Hill (University of Colorado) stressed the urgent need to address the obesity epidemic yet cautioned that we have few proven programs for preventing or treating obesity. Although many different plans can produce significant weight loss, the real challenge is preventing weight regain. Data from the National Weight Control Registry found 4 strategies to be most helpful in keeping weight off: eating a low-fat (24%), high-carbohydrate diet; eating breakfast daily; frequently self-monitoring weight and food intake; and performing approximately 60 minutes of physical activity per day.


Dr Stephen Daniels (University of Colorado) emphasized that the childhood epidemic has occurred too rapidly to be the result of genetic changes. This means that it results from increases in energy intake and decreases in energy expenditure. He challenged the audience to work with families, schools, and communities to reduce sedentary behaviors in children and empower parents to change the home environment, including changes in available foods.

PCNA National Sympos... - Click to enlarge in new windowPCNA National Symposium attendees take a break from sessions to visit with exhibitors.

Dr Penny Kris-Etherton (Penn State University) carefully reviewed the "Dietary Guidelines for Americans 2005" and the variety of available tools for implementing these guidelines. Dr Theodore Feldman (South Miami Heart Center) went beyond the lifestyle approach for weight loss and reviewed the pharmacologic and bariatric surgery alternatives for managing obesity.


Crossing Cultures and Ethnicities: The Global Markers of CVD

Dr Thomas Pearson (University of Rochester) took us beyond the usual focus of CVD as the number 1 killer in the United States to the fact that heart disease and stroke have become the leading cause of death in the world since the 1990s, with 80% of CVD deaths being in low- and middle-income countries. He emphasized that any approach to reducing the CVD burden must begin at the community level by addressing the population-wide behaviors known to cause CVD because secondary approaches requiring expensive technologies and drug therapies will not be feasible in low income countries. He described the Grenada Heart Project in the southern Caribbean as using a chronic care model that supports nurses in managing CVD risk factors.


Genetics: The Future of CVD Prevention

Dr Donna Arnett (University of Alabama) emphasized that most CVD results from both common genetic polymorphisms and environmental factors. Elucidating such gene-gene and gene-environment interactions will be a major research focus in the era of cardiovascular genomics, as will simple descriptive studies to show how genetic variation frequencies differ across populations.


Biomarkers and Imaging: New Methods for Early Identification of Risk

Dr James Stein (University of Wisconsin) tackled the issue of whether we need new tests to identify CVD risks. Using data from the 52-country INTERHEART study, he reported that 5 risk factors (smoking, hypertension, diabetes, abnormal lipids, and obesity) accounted for 80% of the population-attributable risk of myocardial infarction; all 9 common risk factors equal 90%. He emphasized that for most people, new tests are not needed. He also cautioned that just because a test like C-reactive protein is a risk marker, it probably is not a "risk factor."


Skill Sets for Behavioral Change

Nancy Houston Miller (Stanford University) provided an outstanding overview of the complex process of health behavior change. She reviewed the major components of social learning theory, stages of change, relapse prevention, and the health belief model. She challenged all healthcare professionals to adopt new skills of communication (active listening, empathy, and motivational interviewing), education (personalized messages, offering key information, and confirming understanding), and coaching, the cornerstone to health behavior change. Only by adopting these behaviors can nurses increase the likelihood of success in helping their clients adopt and maintain long-term health behaviors.


2006 Preventive Cardiovascular Nurses Association National Symposium Poster Abstract Winners

PCNA congratulates the following abstract/poster winners who presented their research or clinical management strategies at the annual meeting.


First Place: Data-based Research



Authors: Nancy T. Artinian, PhD, MSN; Olivia G.M. Washington, PhD, MSN; Cheryl K. Nordstrom, PhD, MPH; Kai-Lin C. Jen, PhD; John M. Flack, MD, MPH, Wayne State University, Detroit, Mich.


There is an urgent need to find better ways to control and treat high blood pressure (BP), especially among African Americans. Objective: The aim of this study was to test the hypothesis that individuals who participate in usual care plus BP telemonitoring (TM) will have a greater positive change in BP from baseline to 3-months follow-up than will individuals who receive usual care only. Methods: A randomized, 2-group, experimental, longitudinal design with block-stratified randomization for antihypertensive medication use was used. African Americans (n = 163 in TM group; n = 157 in usual care group) with hypertension were recruited through free BP screenings offered in the community. Data were collected by a structured interview and brief physical examination. Cross tabs and repeated-measures analysis of variance were used to analyze the study's hypothesis. Results: Systolic and diastolic BP dropped in both groups [multivariate F(2, 317) = 34.147, P < .001]; however, the change was significantly greater in the TM group [interaction F(2, 317) = 8.231, P < .001]. In the TM group, systolic BP dropped from the baseline level of 157.3 +/- 19.7 mmHg to the 3-month follow-up level of 142.9 +/- 18.8 mmHg. Diastolic BP dropped from 90.1 +/- 13.6 to 83.2 +/- 12.7 mmHg. In the usual care group, systolic BP dropped from the baseline level of 155.7 +/- 20.3 to 150.7 +/- 20.9 mmHg. Diastolic BP dropped from 88.5 +/- 12.9 to 86.2 +/- 12.9 mmHg. Conclusions: Blood pressure TM resulted in clinically and statistically significant reductions in systolic and diastolic BP over a 3-month period, which, if maintained over a longer period of time, can significantly improve care and outcomes for African Americans with hypertension.


Second Place: Data-based Research



Authors: Susan J. Appel, PhD, APRN, BC, CCRN; Natalie A. Floyd, MSN, ACNP, BC, Doctoral Student, School of Nursing, University of Alabama Birmingham.


Third Place: Data-based Research



Author: Sarah Choi, RN, MSN, FNP, PhD(c), School of Nursing, University of California San Francisco.


First Place: Clinical Patient Management



Authors: Keathe A. Hanley, RN, MBA; Helen Graham, PhD, RN-BC; Sharon Pletcher, BSN, RN; Ramona Beal, BSN, RN; Janet Jones, RN, Centura Penrose St. Francis Health Services, Colorado Springs, Colo.


Background: Chronic heart failure (CHF) as a primary diagnosis is the leading cause for hospital admissions and readmissions in the United States. Recently, the Centers for Medicare and Medicaid informed hospitals that inpatient CHF teaching is required before hospital discharge. Objective: Accurate identification of primary CHF patients by nurse educators is necessary when planning inpatient discharge education. However, relying on the documented admitting chief complaint for the identification of primary CHF patients has proven not to be the best method for correct identification because the actual diagnosis is not coded until discharge. Plan: To improve the CHF identification process at this hospital, cardiac rehabilitation nurses created an algorithm based on decision-making theory. Components of the algorithm included beta naturetic peptide, chest x-ray interpretation, ejection fraction, clinical presentation including jugular venous distension, and past medical history. Since implementing the algorithm, the effectiveness of the education intervention has increased, and several noteworthy outcomes have been observed. Results: The successful identification of patients with CHF for the first 2 quarters of 2005 at this hospital is 89%, and the overall success rate for hospitals in Colorado, according to the Colorado Foundation for Medical Care, in the last quarter of 2004 was only 24%. Based on electronic medical record data and cardiology education records, descriptive statistics revealed that the readmission rate for a diagnosis of primary CHF decreased from 12% (pre-algorithm implementation) to 9% (post-algorithm implementation) in 2004. Conclusions: Using a well-designed algorithm can enhance clinical practice and improve program effectiveness.


Second Place: Clinical Patient Management



Authors: Joyce Malaskovitz, RN, PhD, CDE; Susan Michael, RN, DNSc, CDE, Diabetes Treatment Center at Desert Springs Hospital; Prem Kittusamy, MD, Nevada Heart & Vascular, Las Vegas, Nev.


Third Place: Clinical Patient Management



Authors: Soes Madelung, RN; Nikolaj Eldrup, MD; Henrik Sillesen, MD, DMSc, Rigshospitalet, Copenhagen, Denmark.

Figure. Lynne Braun ... - Click to enlarge in new windowFigure. Lynne Braun and Lynn Cofer take a moment to study 1 of the 28 posters that were presented at the 2006 National Symposium.

New Resources and Learning Opportunities from PCNA

The Preventive Cardiovascular Nurses Association (PCNA) is pleased to announce the upcoming release of National Guidelines and Tools for Cardiovascular Risk Reduction: A Pocket Guide. This second edition guide is a single resource that provides information on multiple national guidelines, recommended treatment goals that pertain to both primary and secondary prevention of cardiovascular disease, and information on compliance strategies for the enhancement of risk factor reduction interventions. More specifically, the Pocket Guide includes information and guidelines on cardiovascular risk assessment and prevention, lifestyle interventions, cholesterol, hypertension, obesity/weight loss, diabetes, and smoking cessation. The unique compilation of guidelines and tools is designed to facilitate the healthcare professional's ability to initiate global risk factor assessment, identify appropriate goals, and optimize cardiovascular disease treatment. The guide is intended to fit in the pocket of a laboratory coat as a quick, reliable, and comprehensive reference.


As a member benefit, PCNA members will receive a complimentary copy of the Pocket Guide by mail, accompanied by the Tarascon Pocket Pharmacopoeia Classic. The Pharmacopoeia provides the most up-to-date prescription information and will greatly enhance the Pocket Guide.


Attendees at the PCNA Annual Meeting in Denver received a new companion piece to the Pocket Guide entitled "A Quick Look at Cholesterol Guidelines." This 5x7-inch laminated card features several helpful clinical tools, including (1) Framingham Risk Assessment, (2) Assessment Guide for Metabolic Syndrome, (3) Lipid Treatment Goals, (4) Progression of Drug Therapy, and (5) Targets and Goals of Lifestyle Therapy. Members of the PCNA will receive a copy of the laminated card along with the Pocket Guide and Pharmacopoeia.


PCNA Forms-A Companion to the Pocket Guide: Practical Information for Your Cardiovascular Risk Reduction Clinic is undergoing revision and will be available as an online resource in August 2006. The new and improved Forms Guide will allow PCNA members to print copy-ready tools and patient education handouts commonly used in cardiovascular risk-reduction clinics. Feedback from PCNA members guided the revision, which includes new resources for teaching patients about healthy lifestyles (activity guidelines, sample menus, and portion control) and an expanded medication section that encompasses antihypertensive medications, oral diabetic agents, and lipid lowering therapies.


Coming soon is a module for 1 contact hour on the "Health Benefits of Omega-3 Fatty Acids and Walnuts." The continuing education curriculum was developed in conjunction with PCNA and supported by an educational grant from the California Walnut Commission. The course highlights the health benefits of omega-3 fatty acids, in general, and walnuts, in particular, and discusses recommendations for relaying information to patients. This learning resource will be available, along with several other free professional education programs on heart failure (coming soon), nutrition, depression and cardiovascular disease, and diabetes and cardiovascular disease, at


A Message From the Preventive Cardiovascular Nurses Association's Editorial Committee

The Preventive Cardiovascular Nurses Association Board wishes to thank Dr Jerilyn Allen for her dedicated work serving on the Communications Committee and as coeditor for Preventive Cardiovascular Nurses Association's pages in JCN. Jeri has been instrumental in posting timely features and announcements. She will be replaced by Dr Cheryl Dennison, an assistant professor from Johns Hopkins University School of Nursing. Cheryl is a prolific author, funded researcher, national speaker, and Preventive Cardiovascular Nurses Association member. Dr Meg Gulanick and Jane Nelson Worel will continue as coeditors. Welcome, Cheryl!


Section Description

The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.