Striving for Excellence in the Care of Cardiac Patients

Tone M. Norekval, Chair of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) European Society of Cardiology
Tone M. Norekval, Chair of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) European Society of Cardiology
Cardiovascular disease (CVD) is the main cause of death in the European Union, killing over 2 million people per year. These deaths cost the economy 301.5 billion U.S. dollars annually. Many of these deaths could be averted with proper prevention policies. Cardiac nurses and allied health professionals are on the frontline of the battle to reduce the burden of cardiovascular disease in Europe. Cardiac research and development lead to rapid clinical changes, which require nurses to be updated with the latest information on treatment and care. The CCNAP Spring Meeting helps us to keep abreast of this advancement to the benefit of our patients. Sessions this year included topics on “Acute and Chronic Heart Failure,” “Improving Care in Hospital and Community,” “Coping with Patient and Family Issues at End of Life,” “Prevention and Support in Transplant,” and “Can We Achieve Excellence in Care of Patients with Atrial Fibrillation?” among others. Because we are in the forefront of the drive for prevention, this year it was an important topic on our agenda including abstracts on how to assess risk, advise patients and treat them. Patient adherence to treatment is also one of the areas we are concerned about. Individuals left on their own do not seem to stick to prescribed treatment and lifestyle change recommendations. A number of presentations this year showed that education, counseling and follow-up of patients by nurses significantly increases patients’ handling of risk factors. This leads us to believe that more nurse-led patient education programs and clinics would be useful. In addition, multidisciplinary ambulatory preventive programs should be available to all coronary patients. The intervention of spouses and other helpers has also shown to improve the tendency towards poorer self-care over time. Studies showed that patients who made changes were more likely to have partners that had also made changes, supporting the principle of family-based CVD prevention. This is important, since information is often given only to patients. It also indicates that unmarried patients may need additional support during recovery. This year we also looked into caring for caregivers. Not many studies have taken into account that nursing someone with heart failure or a relative who has recently undergone major surgery is a family affair. Caregivers experience physical and psychological changes due to stress and fatigue. They should be considered in our rehabilitation programs. EUROASPIRE III results were also discussed at our meeting. This survey was conducted in 75 hospitals in 22 countries in 2007, investigating lifestyle and risk factor management in coronary patients following their cardiac event. According to the results of this survey, only half of all smokers had given up smoking a year after their event, with women smoking more than men. Most patients had altered their diets, but only one-third had increased their physical fitness and most remained overweight. Furthermore, only one-third had access to a cardiac rehabilitation program. This means there is considerable potential to raise the standard of preventive care in Europe through programs involving multidisciplinary teams of health care professionals helping patients to achieve the lifestyle and therapeutic targets prescribed by their doctors. Gender issues continue to attract our attention. One abstract showed that although there has been a considerable effort recently to educate women on the dangers of CVD, a majority of them do not see themselves as at risk for coronary heart disease. When experiencing warning symptoms, many women try to persuade themselves that the symptoms will disappear; they attempt to handle the pain and discomfort rather than seeking professional care. Another abstract presented showed that cardiovascular disease in women has also been misunderstood by health professionals due to the fact that women tend to experience coronary heart disease differently than men. Other studies relating to gender differences explored the outcome of coronary bypass surgery; the impact of gender on acute coronary events; female sexual dysfunction related to hypertension and use of oral contraceptives in women with congenital heart disease. Preventing the death of young athletes is equally a cause for concern. Annual CV check-ups should be mandatory, because as with women, young people do not see themselves as candidates of heart disease. There is a need to inform sportspersons of risks and conduct preventive surveillance among young people, particularly athletes, whose hearts suffer greater pressure. Interesting studies on the outlook of life after cardiac arrest show constant anxiety or fear of it happening again. Being aware of their own mortality led patients to change their priorities and goals in life. Although the people interviewed stated that they avoided thinking too much about what had happened and that life was back to normal, the studies presented at our meeting showed they in fact lived in the shadow of their cardiac arrest. Depression is also known to be prevalent in heart failure patients. Separate studies showed that depressed patients have a higher chance of being readmitted and that the length of readmission was significantly longer. Another study proved that depression does not impair knowledge acquisition, so these patients are capable of understanding the importance of sticking to prescribed treatments and lifestyle changes. Cardiovascular nurses have been an important contributor to improving heart health since the initiation of the coronary care units in the 1960s. Since that time, cardiovascular nursing has evolved immensely along with developments in technology and the treatment and prevention of heart disease. The need for specialized skills in cardiovascular nursing became apparent in many European countries at a very early stage, but today there is a great diversity as to education and nurse density in the European countries. Through our meetings and educational courses, we wish to offer all European nurses the opportunity to update their knowledge and practical skills. Today, patient education and support are important parts of the cardiac nursing role, with a special focus on teaching patients self management. There has been some research on the outcome of nursing intervention, but at the CCNAP, we believe that more investigation needs to be conducted on the unique role of cardiovascular nurses and allied health professionals in patient education and risk factor management in the prevention of cardiovascular disease, as well as in acute cardiac care. Through our annual meeting, we hope to stimulate and promote this research. This year, abstracts were accepted from 18 different countries. We hope to see an increase in cardiovascular nursing research capacity in the future, and we invite all professionals interested in our field to join CCNAP. Next year’s Spring Meeting will take place in Dublin, Ireland on April 24-25, 2009. For more information, please visit us at: www.escardio.org/congresses/ cardio-nursing-conference/. The CCNAP regularly participates in various European meetings, organizes scientific sessions, works with Cardiovascular Nursing Associations in Europe and the US and publishes the European Journal of Cardiovascular Nursing with 4 issues per year. For more information, please visit: www.escardio.org/bodies/councils/CCNAP/ The European Society of Cardiology (ESC) represents more than 50,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe. For more information, please visit: www.escardio.org The program for the 8th annual Spring Meeting on Cardiovascular Nursing is available at: www.escardio.org/bodies/councils/CCNAP/Events-calendar/ For more information about EuroAspire III, please visit: www.escardio.org/initiatives/prevention/prevention-initiatives/euroaspireiii.htm For access to full content of abstracts presented at the CCNAP Spring Meeting, please visit: www.sciencedirect.com/science/journal/14745151