Advertisement

Call to action: Nursing action necessary to prevent one million heart attacks and strokes by 2017

        Despite repeated national attempts to prevent and manage cardiovascular disease (CVD), it remains a leading public health problem in the United States today with costs estimated to exceed $289 billion (
        Anonymous
        ,
        • Mozaffarian D.
        • Benjamin E.
        • Go A.
        • Arnett D.
        • Blaha M.
        • Cushman M.
        • Turner M.
        Heart disease and stroke statistics—2015 update: A report from the American Heart Association.
        ). Several risk factors contribute to the burden of CVD. One third of all Americans have hypertension, and approximately half of those affected do not have it controlled (
        • Mozaffarian D.
        • Benjamin E.
        • Go A.
        • Arnett D.
        • Blaha M.
        • Cushman M.
        • Turner M.
        Heart disease and stroke statistics—2015 update: A report from the American Heart Association.
        ,
        • Lloyd-Jones D.
        • Adams R.
        • Carnethon M.
        • De Simone G.
        • Ferguson T.B.
        • Flegal K.
        • Hong Y.
        American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke statistics: 2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        ,
        • Ong K.L.
        • Cheung B.M.
        • Man Y.B.
        • Lau C.P.
        • Lam K.S.
        Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004.
        ). Seventy percent of American adults are overweight (
        National Center for Health Statistics
        Health, United States, 2013: With special feature on prescription drugs.
        ); too many are still exposed to tobacco products and secondhand smoke (
        • Cahn Z.
        • Siegel M.
        Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?.
        ,
        • Mozaffarian D.
        • Benjamin E.
        • Go A.
        • Arnett D.
        • Blaha M.
        • Cushman M.
        • Turner M.
        Heart disease and stroke statistics—2015 update: A report from the American Heart Association.
        ,
        • Popova L.
        • Ling P.M.
        Alternative tobacco product use and smoking cessation: A national study.
        ,
        U.S. Department of Health and Human Services
        The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general.
        ,
        U.S. Department of Health and Human Services
        A report of the surgeon general: How tobacco smoke causes disease: What it means to you.
        ,
        U.S. Department of Health and Human Services
        Preventing tobacco use among youth and young adults: A report of the surgeon general.
        ,
        U.S. Department of Health and Human Services
        The health consequences of smoking-50 years of progress: A report of the surgeon general.
        ), and few consistently exercise (
        National Center for Health Statistics
        Health, United States, 2013: With special feature on prescription drugs.
        ). With more intensive efforts, the Centers for Disease Control and Prevention (CDC) estimate that >200,000 deaths per year should be able to be prevented. Although many advanced practice registered nurses (APRNs) and registered nurses specializing in cardiovascular care are aware of the persistence of CVD, the three million members of the largest health care profession in the nation need to rally and commit to combating this disease to meet the CDC's goal of saving one million lives by 2017. However, many nurses have been slow to respond and have never heard of the Million Hearts initiative.
        In 2012, the U.S. Department of Health and Human Services launched the Million Hearts Initiative, which is calling on health care professionals to collaborate with communities, health systems, nonprofit organizations, private sector organizations, and federal agencies to prevent one million heart attacks and strokes by 2017 (
        • Frieden T.R.
        • Berwick D.M.
        The “Million Hearts” initiative—Preventing heart attacks and strokes.
        ). The ABCS of Million Hearts are appropriate aspirin therapy, blood pressure control, cholesterol management, and smoking cessation (
        Anonymous
        ).

        Recommendations for All Registered Nurses

        Tabled 1

          Million Hearts Pledge:

        • Talk to your family to help them understand risks for heart disease and stroke that might be passed down from generation to generation;
        • Get active by exercising for 30 min on most days of the week;
        • Know your ABCS:
          • Ask your health care professional about taking aspirin
          • Make control your goal—if you have high blood pressure, work with your health care professional to get it under control
          • Manage high cholesterol
          • Stop smoking or do not start
        • Eat a heart-healthy diet that is high in fresh fruits and vegetables and low in sodium, saturated and trans fat, and cholesterol
        • Follow your health care professional's instructions when it comes to taking medications or measuring your blood pressure at home


        Used with permission from Preventing 1 Million Heart Attacks and Strokes: A Turning Point for Impact (
        U. S. Department of Health and Human Services Million Hearts
        Preventing 1 million heart attacks and strokes: A turning point for impact.
        )
        Registered nurses work in numerous settings where they can influence practice, education, research, and health policy to achieve the Million Hearts goal. The following recommendations are listed by categories of influence type. Recommendations that are bolded are either easy to immediately implement or are a high priority.

        Clinical Practice Recommendations Based on Best Evidence

        • Assess physical activity in preschool children, ages 3 to 5 years and recommend 120 min of physical activity daily.
        • Assess physical activity in children and youth, aged 6 to 17 years and recommend participating in at least 60 min of physical activity daily.
        • Assess physical activity in adults and recommend engaging in at least 150 min a week of moderate-intensity aerobic physical activity per week.
        • Educate all adults, 18 years and older, about Million Hearts and screen for the ABCS as well as encourage them to know their numbers (e.g., blood pressure, cholesterol).
        • Use proper technique for accurate blood pressure measurement and educate patients about their BP numbers.
        • Take a holistic approach to cholesterol management that includes suggesting increased physical activity, dietary and lifestyle modifications, and pharmaceutical management in accordance with national guidelines. Research has demonstrated that the type of diet instituted for weight loss is less important than the palatability and the ability to continue the diet long term (
          • Makris A.
          • Foster G.
          Dietary approaches to the treatment of obesity.
          ).
        • Educate regarding healthy lifestyle behaviors and stress reduction as part of all well/preventive visits across the life span to all, regardless of ethnicity, education level, or income status. Use evidence-based interventions which are age, developmentally and culturally tailored and targeted.
        • Routinely assess adherence to the prescribed lifestyle changes and medications during follow-up appointments to evaluate patient adherence and motivation to continue on the regimen.

        Research Call to Action

        • Studies of psychological and stress-reducing interventions for CVD have primarily included subjects with diagnosed CVD. As stress is thought to play a role in the pathogenesis of CVD, more studies need to be conducted in younger, healthy subjects to evaluate the long-term effects of stress-reducing interventions on the primary prevention of CVD.
        • More longitudinal randomized controlled trials testing interventions to promote healthy lifestyle behaviors in children and adolescents are needed to assess sustainability of outcomes over time.
        • Mediating and moderating variables should be assessed as part of randomized controlled trials that test strategies to prevent or treat CVD to explain the process through which intervention works and what factors influence outcomes.
        • Dissemination/implementation studies are needed to determine which types of interventions result in the greatest uptake of evidence-based guidelines and recommendations with health care providers in real-world practice settings.
        • Studies determining the impact of regional or national policies on health outcomes are needed.

        Educational Call to Action

        • All nursing and health professional students should know their own CV numbers (e.g., BP, cholesterol, body mass index) and engage in healthy lifestyle behaviors.
        • Educational programs should incorporate intense didactic and clinical experiences focused on CVD prevention and management, including evidence-based interventions to promote healthy lifestyle change in individuals, groups, and communities across the life span.
        • Educational programs should make health professional students aware of health inequality and health disparities that persist in the United States.
        • Colleges should provide cultures and environments that promote healthy lifestyle behaviors in faculty, staff, and students, including physical activity, healthy eating, and stress reduction.
        • Colleges should incorporate Million Hearts into their educational programs. A free transdisciplinary educational module on Million Hearts is currently available through The Ohio State University Colleges of Nursing, Medicine, and Pharmacy at http://millionhearts.osu.edu as part of the National Interprofessional Education and Practice Consortium to Advance Million Hearts. The goal of this national consortium is to screen and educate 100,000 people across the United States about Million Hearts by 2017.

        Health Policy Call to Action

        • Federal funding should be increased for team-based health care clinics, including nurse-led clinics, and evidence-based interventions that incorporate CVD prevention and management across all ethnic and socioeconomic groups.
        • All insurers should be required to competitively reimburse direct APRN care for CVD prevention and treatment.
        • Nurses must be represented in all key federal and national discussions surrounding health policies.
        • Parity and reimbursement for evidence-based preventive interventions and counseling regarding healthy lifestyle behaviors must be provided across the life span.
        • Legislation needs to be passed to mandate evidence-based healthy lifestyle intervention programs, including daily physical activity, in schools for children and adolescents from first through twelfth grades.
        • Tobacco use (smoking) is a health risk behavior engaged in by a variety of individuals, including 11% of all nurses (the largest proportion of health professional), that must be assessed and addressed as a critical component of CVD prevention and wellness promotion among nurses as well as the patients and families for whom nurses provide care.

        Stay Connected

        Acknowledgments

        The American Academy of Nursing acknowledges the Health Behavior Expert Panel Subcommittee on the Million Hearts Initiative: Bernadette Mazurek Melnyk, PhD, RN, FAANP, FNAP, FAAN, Co-Chair; Liana Orsolini, PhD, RN, ANEF, FAAN, Co-Chair; Lynne T Braun, PhD, CNP, FAHA, FAAN; Deborah A. Chyun, PhD, RN, FAHA, FAAN; Vicki S. Conn, PhD, RN, FAAN; Jacqueline Dunbar-Jacob, PhD, RN, FAAN; Lisa M. Lewis, PhD, RN, FAAN; Gail D'Eramo Melkus, EdD, C-NP, FAAN; Angelica Millan, MSN, CNS, RNP, FAAN; Virginia Hill Rice, PhD, RN, CS, FAAN; and JoEllen Wilbur, PhD, APN, FAAN.

        References

          • Anonymous
          Preventing 1 million heart attacks and strokes: A turning point for impact. Department of Health and Human Services, 2014 (Retrieved from)
        1. Anonymous. HealthyNurse ™ http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse.

          • Cahn Z.
          • Siegel M.
          Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?.
          Journal of Public Health Policy. 2011; 32: 16-31
          • Frieden T.R.
          • Berwick D.M.
          The “Million Hearts” initiative—Preventing heart attacks and strokes.
          New England Journal Medicine. 2011; 365: e27
          • Lloyd-Jones D.
          • Adams R.
          • Carnethon M.
          • De Simone G.
          • Ferguson T.B.
          • Flegal K.
          • Hong Y.
          • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
          Heart disease and stroke statistics: 2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
          Circulation. 2009; 119: 480-486
          • Makris A.
          • Foster G.
          Dietary approaches to the treatment of obesity.
          Psychiatric Clinics of North America. 2011; 34: 813-827
          • Mozaffarian D.
          • Benjamin E.
          • Go A.
          • Arnett D.
          • Blaha M.
          • Cushman M.
          • Turner M.
          Heart disease and stroke statistics—2015 update: A report from the American Heart Association.
          Circulation. 2015; 131: e29-e322
          • National Center for Health Statistics
          Health, United States, 2013: With special feature on prescription drugs.
          (Hyattsville, MD)2014 (Retrieved from)
          • Ong K.L.
          • Cheung B.M.
          • Man Y.B.
          • Lau C.P.
          • Lam K.S.
          Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004.
          Hypertension. 2007; 49: 69-75
          • Popova L.
          • Ling P.M.
          Alternative tobacco product use and smoking cessation: A national study.
          American Journal of Public Health. 2013; 103: 923-930
          • U. S. Department of Health and Human Services Million Hearts
          Preventing 1 million heart attacks and strokes: A turning point for impact.
          2014 (Retrieved from)
          • U.S. Department of Health and Human Services
          The health consequences of smoking-50 years of progress: A report of the surgeon general.
          U.S. Department of Health and Human Services, Atlanta2014 (Retrieved from)
          • U.S. Department of Health and Human Services
          The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general.
          U.S. Department of Health and Human Services, Atlanta2006 (Retrieved from)
          • U.S. Department of Health and Human Services
          A report of the surgeon general: How tobacco smoke causes disease: What it means to you.
          U.S. Department of Health and Human Services, Atlanta2010 (Retrieved from)
          • U.S. Department of Health and Human Services
          Preventing tobacco use among youth and young adults: A report of the surgeon general.
          U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2012 (Retrieved from)