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On our radar: Cardiac care

Nursing study finds poor health literacy poses risks for pacemaker, defibrillator patients

A study from Columbia University School of Nursing in New York published in an August issue of the Journal of Cardiovascular Nursing found that 40% of patients with pacemakers and defibrillators had little to no understanding of information about their cardiac health.

“As a nurse practitioner, I use every patient encounter as an opportunity for education,” lead author Kathleen Hickey, EdD, ANP-BC, FNP-BC, assistant professor at Columbia Nursing, said in a news release. “Health literacy is a particular concern for patients with pacemakers and defibrillators because these patients need to know how to respond if they get a shock from their device. Even when the device is quiet, they often need to know how to manage co-existing health conditions like diabetes, heart failure and high blood pressure.”

Risks can stem from some common misunderstandings between patients and clinicians, Hickey said. A patient might ignore advice to avoid rigorous exercise and then be surprised when experiencing an irregular heartbeat, for example. Or, patients instructed to check their pulse regularly and report any abnormal activity might not understand how to do this or what heart rate is cause for alarm.

“It’s not enough just to explain the same thing again in the same way,” she said in the release. “You have to stop to ask more specific questions like what activities they do in a typical day and offer simple instructions so they understand, for example, the appropriate heart rate zone for exercise.”

To understand the scope of potential communication problems at the clinic where she practices in New York City, Hickey and a team of researchers evaluated the health literacy of 116 patients using a standard measure of reading and math comprehension, the Test of Functional Health Literacy in Adults. The study population was 37.1% white, 39.7% Hispanic and 22.4% African-American. Of that population, 77.4% reported finishing high school. The average age of the study population was 68. Evaluations were done in English or Spanish. Almost 30% of participants had inadequate health literacy, and another 10% were marginal, the study found. According to the CDC, limited health literacy is associated with poorer health outcomes, higher rates of hospitalizations, increased use of the ED, improper use of medications and higher healthcare costs.

The study, “Assessing Health Literacy in Urban Patients with Implantable Cardioverter Defibrillators and Pacemakers,” also examined literacy among patients with medical conditions common among those with pacemakers and defibrillators. Individuals with hypertension or high cholesterol were more than twice as likely to have limited health literacy as people without those conditions. Patients with diabetes were almost twice as likely to have low health literacy, the findings showed.

Heart Failure Society of America names FSU professor award finalist

A Florida State University researcher was named a finalist for the Heart Failure Society of America’s Nursing Research Award for her study identifying predictors of depressive symptoms and poor self-care behaviors in heart failure patients.

Lucinda J. Graven, PhD, MSN, ARNP, an assistant professor in the College of Nursing in Tallahassee, investigated the relationships among heart failure symptom severity, social support, social problem-solving, depressive symptomatology and self-care behaviors in individuals with heart failure. The study is scheduled to be published in the American Journal of Health Behavior in January 2015, and a pilot study portion was published in the peer-reviewed journal Home Healthcare Nurse in October.

“There are more than 5.8 million people living in the United States who suffer from heart failure,” Graven said in a news release announcing her achievement. “One of the things we know from the research is that in patients with heart failure, upwards of 50% of those people suffer from depression or depressive symptoms. We also know in heart failure patients over the age of 65 that heart failure is one of the leading diagnoses for hospitalizations.”

The study examines psychosocial variables, particularly social support and how patients perceive their social network, and social support availability. The statistical method structural equation modeling allowed Graven to look at the relationships between all of these variables in one single analysis.

“It’s important to look at both of those aspects when trying to discern what could potentially lead to these poor outcomes,” Graven said.

In addition, Graven studied social problem-solving in patients and how they perceive their problems, or problem orientation. The study evaluated how patients appraised their problems, their problem-solving styles and their effects on outcomes.

“It was very important to see how they solve problems in a real world environment and if that potentially predisposes them to either depressive symptoms or poor self-care,” Graven said in the release.

As a precursor to the actual study, Graven completed preliminary psychometrical analyses for a new social network instrument she developed and hopes to expand and test in people with various chronic disorders.

Graven was one of five finalists who competed for the Nursing Investigator Award at the HFSA’s Annual Scientific Meeting Sept. 16 in Las Vegas, where she presented her research.

North Shore-LIJ Health System becomes specialty network member

The Cleveland Clinic Heart & Vascular Institute has selected the North Shore-LIJ Health System to serve as its exclusive alliance member in the New York metropolitan area.

The unique alliance between the Cleveland clinic and the Manhasset, N.Y.-based health system is aimed at providing cardiac patients in the New York metropolitan area with new and enhanced treatment options and greater access to clinical trials and technologies in cardiology and cardiac surgery.

“We’re honored that the best heart hospital in the world has selected North Shore-LIJ as its exclusive New York alliance member,” Michael J. Dowling, president and CEO of the North Shore-LIJ Health System, said in a news release announcing the union.

“This collaboration further strengthens a heart program already recognized as one of the best in New York.”

Cleveland Clinic selected North Shore-LIJ as a member of its alliance and national cardiovascular specialty network after a yearlong, operational assessment of its cardiology, cardiac surgery and electrophysiology programs, including an analysis of operating rooms, ICUs, work flows, policies and procedures, mortality rates, imaging capabilities and other services, according to the release.

North Shore-LIJ becomes only the second health system in the nation to be named an alliance member and cardiovascular specialty network member of Cleveland Clinic’s world-renowned Sydell and Arnold Miller Family Heart & Vascular Institute. The MedStar Heart Institute in Washington, D.C., became an alliance member in 2013.

“As the delivery of healthcare continues to evolve and medicine moves from an art to a science, it’s crucial that healthcare organizations maintain databases to track clinical measures and quality standards,” Toby Cosgrove, MD, president and CEO of Cleveland Clinic, said in the release. “This new alliance is an opportunity to work closely with an organization that, like Cleveland Clinic, uses measurable, objective data to enhance patient care and safety. This is how healthcare becomes safer, less expensive and more efficient.”

North Shore University Hospital is part of a unified cardiac services program that also includes health system hospitals LIJ Medical Center in New Hyde Park, N.Y., Lenox Hill Hospital in Manhattan, Staten Island (N.Y.) University Hospital and Southside Hospital in Bay Shore, N.Y. As the destination site for Cleveland Clinic referrals, North Shore University Hospital performs about 700 open-heart surgeries, 2,200 interventional procedures and 1,300 electrophysiology procedures annually.

Researchers find tissue valves to be safe as mechanical valves over long term

No significant difference in 15-year survival or stroke rates was found in patients between 50 and 69 years of age who had aortic valve replacement with bioprosthetic valves (made primarily with biological tissue) compared with mechanical valves, according to findings published in the Oct. 1 issue of JAMA. The study results show patients in the bioprosthetic valve group had a greater likelihood of reoperation but a lower likelihood of major bleeding.

According to the study, conducted by researchers at the Icahn School of Medicine at Mount Sinai, New York City, about 50,000 patients have aortic valve replacement surgery each year in the U.S. In elderly patients, bioprosthetic valves pose a low lifetime risk of needing additional surgeries to address structural degeneration and avert many of the complications associated with mechanical valves; bioprosthetic valves are therefore recommended in patients older than 70. Less clear is the best prosthesis type for younger patients because of the higher failure rates of bioprosthetic valves in that age group.

Lead author Joanna Chikwe, MD, associate professor in the department of cardiovascular surgery at Icahn said the new evidence may help patients who want to avoid the complications and lifestyle limitations associated with mechanical valves.

“This is one of the largest studies to date on the long-term outcomes of treatment of patients with aortic valve replacement,” the study’s senior author Natalia Egorova, PhD, MPH, assistant professor in the department of population health science and policy at Icahn, said in a news release. “The previous prospective studies have been underpowered to detect differences in long-term survival and major morbidity in the younger age group that we studied.”

The study’s authors used a statewide patient database to evaluate differences in long-term survival, stroke, reoperation and major bleeding episodes after aortic valve replacement according to the type of valve implanted. The analysis included 4,253 patients aged 50 to 69 years who underwent primary isolated aortic valve replacement using bioprosthetic versus mechanical valves in New York state from 1997 through 2004. Median follow-up time was 10.8 years, with a maximum follow-up of 16.9 years.

Fifteen-year survival was 60.6% in the bioprosthesis group compared with 62.1% in the mechanical prosthesis group. The cumulative incidence of stroke at 15 years was 7.7% for patients who received a bioprosthetic valve, compared with 8.6% for those who received a mechanical prosthetic valve. These differences were not statistically significant, according to the release.

Bioprostheses were associated with a significantly higher rate of aortic valve reoperation than mechanical prostheses: the cumulative incidence of aortic valve reoperation at 15 years was 12.1% in the bioprosthesis group and 6.9% in the mechanical prosthesis group.

Mechanical prostheses were associated with a significantly higher rate of major bleeding at 15 years compared with bioprostheses: 13.0% for the mechanical prosthesis group vs. 6.6 % for the bioprosthesis group.

“These outcomes, together with the well-recognized patient dissatisfaction with the prospect of a lifetime of anticoagulation, may partially explain the increasing use of bioprostheses,” the study’s authors wrote.

Organization specializing in heart patients joins ANA as affiliate

The American Association of Heart Failure Nurses has joined the American Nurses Association as an organizational affiliate, bringing the number of ANA partner organizations to 33. AAHFN supports nurses who provide holistic care to people with various heart conditions and diseases. Heart failure nursing care can take place in any inpatient or outpatient setting and addresses the acute or chronic needs of patients and their support systems.

“Being an ANA organizational affiliate provides AAHFN with an avenue to stay connected with the nursing community and gives us an opportunity to impact the nursing care of our patients,” Peggy Kirkwood, MSN, RN, ACNPC, CHFN, AACC, AAHFN immediate past president, said in a news release. “We are proud to represent heart failure nurses in this arena.”

AAHFN unites professionals in the support and advancement of heart failure practice, education and research to promote optimal patient outcomes. It is dedicated to advancing nursing education, clinical practice and research with the goal of setting the standards for heart failure nursing care. Through affiliation with ANA, nursing-related organizations advocate independently on issues specific to their expertise while also benefiting from a larger, united presence committed to strengthening the nursing profession as a whole and improving patient outcomes, safety and satisfaction in all care settings.

In addition to the AAHFN, the Association of Occupational Health Professionals in Healthcare, a national organization that exclusively addresses the needs and concerns of the occupational professional in healthcare, also has joined the ANA.

“Establishing deeper connections with specialty nursing organizations such as AOHP and AAHFN strengthens the influence of all nurses as ANA works to achieve mutual goals on behalf of nurses and patients,” Karen A. Daley, PhD, RN, FAAN, ANA immediate past president, in the release. “By working together, we enhance the synergy of effort to improve the work environment and the quality of patient care.”

ANA’s 33 specialty nursing affiliates represent roughly 400,000 registered nurses.

Grant funds research to study heart, kidney disease in 9/11 first responders, volunteers

Researchers from Icahn School of Medicine at Mount Sinai, New York City, have received a $1.1 million grant from the World Trade Center Health Program to study the risks of kidney and heart disease among ground zero first responders and volunteers exposed to the toxic dust-cloud created by the disaster 13 years ago, according to a news release.

Responders and volunteers were exposed to varying levels of air filled with cement dust, smoke, glass fibers and heavy metals during at ground zero. Mount Sinai researchers believe high levels of exposure to the dust cloud may cause inflammation that can result in the development of chronic kidney disease and cardiovascular damage.

“Our research will determine the frequency and degree of kidney dysfunction in these patients, and examine the relationship between kidney and cardiovascular diseases among first responders to the tragedy at ground zero and volunteers who were there,” Mary Ann McLaughlin, MD, MPH, medical director of the cardiac health program at Mount Sinai Hospital and the study’s principal investigator, said in the release.

Our long-term goal is to identify and minimize the risks for these conditions among individuals exposed to the inhaled toxins.”

A clinical center of excellence at Mount Sinai is a treatment and monitoring program for emergency responders, recovery workers, residents and area workers affected by the terrorist attacks in New York City in 2001. The program identifies health problems needing timely treatment, monitors the development of symptoms, and analyzes data on the effects of 9/11. Located at Mount Sinai and several other clinics in the tri-state area, the Clinical Centers of Excellence and Data Centers are the result of the James Zadroga 9/11 Health and Compensation Act, which provides $4.3 billion in federal funding to serve the health needs of the men and women affected by the World Trace Center attacks.

Free publication promotes global cardiovascular health

Global authorities in the field of cardiovascular medicine have created a free, special publication produced in collaboration with Scientific American Custom Media. Called “Promoting Cardiovascular Health Worldwide,” this magazine focuses on the growing worldwide epidemic of cardiovascular diseases and offers solutions to improve the promotion of cardiovascular health and prevention of cardiovascular diseases globally, according to a news release announcing the special issue.

The issue, which can be downloaded free, shares the perspectives of leading international cardiac experts building upon the 12 important recommendations issued by the Institute of Medicine of the National Academies in its 2010 special report, “Promoting Cardiovascular Health in the Developing World.” The special issue explores the existing and growing global epidemic of cardiovascular diseases and outlines solutions defining ways to continue to make progress on the IOM’s 12 recommendations. It also highlights 12 corresponding key examples of successful global programs having a true effect on improving cardiovascular health in communities around the world.

“In many corners of today’s world, the measure of people’s overall health is increasingly being defined by their cardiovascular health, especially their blood pressure,” Tom Kenyon, MD, MPH, director, CDC’s Center for Global Health, said in the release.

“Yet in too many places, the news is simply unacceptable.”

Cardiovascular diseases are the leading cause of death across the globe with more than 80% of mortality now occurring in low- and middle-income countries, according to the release. Heart attack, strokes, diabetes and other cardiovascular–related diseases are affecting people across the globe in the higher-income communities of the United States and Europe along with the lower-income small, rural towns and villages of South America and Africa. The epidemic is being fueled by genetics, lifestyle choices, other illnesses, uncontrolled high blood pressure, high cholesterol and diabetes and unhealthy diets high in fat and salt, along with sedentary lifestyles and tobacco use, according to the release.

A special presentation of the magazine by Scientific American took place June 27 at the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid. A free copy of the magazine can be downloaded at www.scientificamerican.com/products/cardiovascular-health.

New technique assists PET scan in detecting cancer, heart conditions

A novel technique that reduces image degradation caused by respiratory motion during a PET scan was developed in a recent study at the University of Eastern Finland. Positron emission tomography is a modern nuclear medicine imaging method routinely used to detect cancer and heart conditions.

PET scanning is used for cancer staging and evaluating treatment response, as well as for studying myocardial blood flow and inflammatory diseases of the heart.

Typically, a PET scan takes several minutes, which is why movement caused by the patient’s breathing inevitably degrades image quality.

Degraded image quality caused by respiratory motion has been reported to affect PET scanning performed to detect cancer and heart conditions in particular.

The new technique is based on bioimpedance measurement, and it allows for image reconstruction at a specific phase of the patient’s breathing pattern, which makes it possible to reduce image degradation caused by motion.

In the future, the newly developed technique will enable increasingly accurate image acquisition especially during PET scans performed to detect cancers of the chest and upper abdomen and inflammatory diseases of the heart.

The study, published in the journals Medical & Biological Engineering & Computing, Physiological Measurement and Physics in Medicine and Biology, found that when synchronizing images on the basis of bioimpedance, it was possible to discern smaller details. The study first used computational models and test subjects to determine an optimized bioimpedance measurement configuration for simultaneous measurement of respiratory and cardiac gating signals. The second phase of the study focused on analyzing whether bioimpedance techniques can be used to reduce respiration-related degradation of PET images.

Bioimpedance measurement offers a straightforward technique for acquiring the data needed for motion compensation. Because of enhanced image quality, PET images provide new and increasingly accurate data, potentially improving diagnosis reliability and treatment response monitoring. High-quality image data make treatment more efficient both medically and financially. Researchers believe the technique also can be integrated easily into electrocardiogram measurement, which is widely used to monitor heart function during the PET scan.

Johns Hopkins nursing school offers cardiovascular health research program

Cardiac nurses interested in cardiovascular research can apply to the Johns Hopkins School of Nursing Interdisciplinary Training in Cardiovascular Health Research program.

The curriculum prepares nurse scientists to build investigative careers directed at improving understanding of behavioral and biologic factors associated with cardiovascular health, illness and risk.

It also aims to increase the number of and strengthen the preparation of early career nurse scientists participating in research, according to the school.

Benefits include full tuition for as long as two years, a National Institutes of Health stipend and money for travel and other training-related expenses for four nurses per year.

Coursework for full-time study includes 24 credits of core courses in philosophy of science, theory, advanced research design, biostatistics, grant writing and scientist responsibilities. Trainees also must complete an additional 22 credits of electives — which can be taken in the Schools of Nursing, Public Health or Medicine — and courses developed specifically for the training program. Elective courses are selected with the help of a faculty mentor who will chart a course of study specific to each student’s goals and develop the basis for a program of research.

Fellows also participate in directed research residencies, skill-building workshops, journal club and research seminars, interdisciplinary co-mentorship and independent research projects.

Nurses interested in applying must be graduates of an accredited bachelor’s or master’s in nursing program, supply a written statement of research goals including reason for interest in the fellowship and submit research interests matching faculty expertise and school resources.

Nurses also must provide GRE scores from within the past five years and have achieved a minimum scholastic GPA of 3.0 on a 4.0 scale. Applicants will interview with faculty and also must provide a writing sample, for example, a published work or graded paper.

Applications may submitted online, and more information can be found by visiting http://nursing.jhu.edu/faculty_research/research/opportunities/doctoral.html.

By | 2014-10-26T00:00:00-04:00 October 26th, 2014|Categories: National|0 Comments

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