AHA Adds Sleep to List of Heart Disease Health Factors

AHA Adds Sleep to List of Heart Disease Health Factors

In 2010, the American Heart Association (AHA) defined “Life’s Simple 7TM,” the seven health behaviors and factors people can improve to help achieve optimal cardiovascular health. And now they’re adding an eighth: sleep.

“Sleep is related to every single one of the other seven elements—it’s closely tied to weight, blood pressure, glucose metabolism, what we choose to eat,” said AHA president Dr. Donald Lloyd-Jones , chair of the department of preventive health at Northwestern University Feinberg School of Medicine. “But sleep is both correlated and also independent. There’s newer research that shows when we take the old seven and add sleep, we can predict cardiovascular disease and stroke even better.”

Now called “Life’s Essential 8TM,” the full list of the AHA’s important health factors includes blood pressure management, cholesterol control, blood sugar reduction, maintaining a healthy weight, increased physical activity, healthier eating, avoiding nicotine in all forms, and now sleep duration.

Although some individuals have a harder time modifying their sleep hygiene, such as those working two jobs or on the night shift, Lloyd-Jones said an important contributor to better cardiovascular health is focusing on ways to get the healthiest amount of sleep (seven to nine hours a night on average) by avoiding caffeine, screens and bright light for several hours before bedtime, putting away your phone and creating a more regular schedule.

A paper on Life’s Essential 8 and the status of cardiovascular health in U.S. adults and children will be published June 29 in Circulation, the flagship journal of the AHA.

“Healthier kids become healthier adults”

A key focus of the re-invigorated list of risk factors is the importance of measuring and monitoring children’s cardiovascular health and learning how to maintain it as they age, Lloyd-Jones said.

“When we create healthier kids, they become healthier adults who then go on to have healthier pregnancies, and the benefits continue with their kids being healthier simply because their parents were healthier,” Lloyd-Jones said. “We get this virtuous cycle of improvement of cardiovascular health generation by generation.”

Additional research published online in Circulation at the same time evaluated the cardiovascular health of U.S. children and adults. Those results showed that as U.S. children ages 2 to 5 grew into the 12- to 19-year-old age group, the healthy diet score fell markedly from 61 to 28 (out of 100 possible points).

“We’re losing a lot of cardiovascular health in the eating patterns as our kids age into later childhood and adolescence,” Lloyd-Jones said. “That doesn’t have to be, but we’re not serving them well…pun intended.”

He said school food programs focused on healthier eating, improving the health of our food supply, helping children choose water over sugary drinks and taxing sugar-sweetened beverages are proven strategies the U.S. can be taking to maintain and improve cardiovascular health in children.

2,500 scientific papers since 2010

The introduction of “Life’s Simple 7” in 2010 was novel, Lloyd-Jones said.

“No one had really tried to quantify health as a concept before that, and it’s been transformative for public health advocacy and for individuals to think about their long-term health,” said Lloyd-Jones, who also is a Northwestern Medicine cardiologist.

Since 2010, more than 2,500 scientific papers have been published about the AHA’s cardiovascular health construct and what it means for improving lifelong health.

“We’ve learned a ton about how important it is to have higher cardiovascular health at every stage of life,” he said. “It affects your risk of stroke, heart attack, cancer, dementia, cognitive functioning, pretty much everything we care about.”

This “cutting-edge research” has paved the way for adding the eighth element of sleep.

More sensitive tools to measure heart health

Also, since 2010 scientists have developed more sensitive tools to determine a person’s cardiovascular health, such as better questionnaires that measure eating patterns in different populations (i.e. the DASH diet versus the Mediterranean diet), Lloyd-Jones said. The new scoring system, he explained, will also better give credit to people who are working to improve their cardiovascular health—something the old scoring system did not do well.

Two elements that affect cardiovascular health are not included in the measurement system: social determinants of health and psychological health characteristics such as optimism, purpose in life, environmental mastery, perceived reward from social roles and resilient coping. Scientists also now know more about how social determinants of health (education, neighborhood environment, community, economic security, access to health care) can affect people’s opportunity for better cardiovascular health. Lloyd-Jones said while policymakers, clinicians and individuals should be mindful of these elements, they’re difficult to quantify and are, therefore, not part of the list of Life’s Essential 8.

How Personalized Telemedicine Can Make a Difference for Heart Disease Patients

How Personalized Telemedicine Can Make a Difference for Heart Disease Patients

Science and medicine have achieved great success when it comes to post-event rehabilitation and recovery. When people are unwell or have chronic conditions, staying engaged with prescribed plans for exercise, reducing stress, diet and nutrition can make all the difference the world.

Most of my patients have heart disease, still the number one killer in the U.S., and we know that a medically directed rehab program after a heart attack or surgery can prevent subsequent issues, reduce rehospitalizations and even avoid fatalities. These rehab plans are primarily focused on movement and exercise, as well as regaining basic living skills like getting dressed, preparing meals, or running errands.

Usually, the doctor refers the patient to a rehab facility located in hospitals and medical centers. But a huge majority DO NOT continue the prescribed rehab and recovery treatment after the first few weeks for myriad reasons including a geographically inconvenient location, or the inability to travel due to infirmity, immobility, expense or scheduling. Some have no support system at home to motivate and encourage them, let alone get them to an outpatient center. While the activity and the direct personal contact are critical for patients who are in recovery, they may also be dealing with feelings of anxiety and isolation.

How to make remote cardiac rehab work for your patients

For the last four years, I have been treating patients around the country through a remote, AI-driven customizable cardiac rehab program that can be used at home or anywhere for patients recovering from a heart attack or other coronary incident, as well as for those determined to be at risk and need preventive care, or prehab. More and more patients are connecting with doctors, nurses, and therapists through telemedicine. But unless someone is overseeing the patient’s engagement, monitoring their progress, entering that data, handling insurance billing…and eventually circling back to make modifications, this technology can’t truly be effective.

Filling in many of the gaps of traditional healthcare, here are a few important things you want to look for in a remote or telehealth cardiac care exercise and activity program:

Remote cardiac rehab care.

  1. Be sure the program is covered by Medicare/Medicaid or commercial insurance and is HIPAA-compliant.
  2. You will want to know what monitoring devices are provided through the program, or if the patient will need to obtain these.
  3. The most effective program have will have a team of healthcare professionals behind it, and one particular care management supervisor who will be the ongoing contact for your patient.
  4. A detailed questionnaire, either in-app or conducted in person, should be the first step.
  5. Find out if the program and/or application will be customized to your patient’s particular fitness and strength levels.
  6. Ask if the program enables the primary physician to monitor and track your patient’s participation and progress in between medical appointments.

I’m able to guide my patients to perform various activities at home through the app once or twice a week.  Proprietary software takes in the data and then fine-tunes the treatment to create a truly customized plan tailored to that individual and their particular situation. No cookie-cutter care, which is particularly critical with patients who may have several comorbidities or be on medications for different issues.

Empowering your patients – and improving health outcomes

Using technology to impact healthcare — but never losing the “human touch” – is part of the global trend to empower patients, lower healthcare costs, provide equal access to treatment, and produce the best possible outcomes. Any member of the medical team can easily review patient progress or regression through an online dashboard, and we receive automated alerts that flag any difficulties the patient may be experiencing.

With all the information at their fingertips, the team can quickly talk with the patient and consult with the primary doctor quickly. This is in stark contrast with the more traditional practice where problems may not be recognized until they’ve become more serious. At any point, the rehab team is seeing both the big picture and any small detail to provide the best outcomes for the patient.

We also integrate a more direct focus on prehab and improvement of physical health, diet, strength, and balance as well as social and mental focus.  This platform is currently designed for cardiac patients; moving forward, we expect to apply the program to work with metabolic disease, endocrine disorders, respiratory disease, or other chronic comorbidities and conditions. We have recently incorporated a treatment program for long-haul Covid recovery.

Nurses are painfully aware of the toll that heart disease exacts on the U.S. population. In this country, one person dies every 36 seconds from cardiovascular disease. As an FNP working with cardiac patients, I cannot understate the value of combining technology with patient education for rehab, or how gratifying it is to see improvements that drive compliance, leading to better health outcomes all around.

CICU Nurses Develop Protocols for PAxIABP Patients

CICU Nurses Develop Protocols for PAxIABP Patients

When transplant cardiologists at the Debakey Heart and Vascular Center at Houston Methodist Hospital, began to use percutaneously placed axillary intra-aortic balloon pumps (PAxIABPs) in 2007, there was one problem. Not with the procedure, which would act as a bridge to heart transplants. But rather, with the nursing care that would take place after. When CICU nurses searched for literature on the subject, there was one problem.

There wasn’t any.

The procedure was so new, so no patient care protocols existed. So they developed them. And now an article about the problems and solutions developed by the nurses is out.

Frederick R. Macapagal, BSN, RN, CCRN, RN, Cardiac Intensive Care Unit, Houston Methodist Hospital, was a part of that team and is a lead researcher on the article. What follows is an edited version of our interview with him

Q: Were you on the original team that discovered that no nursing literature existed on PAxIABPs in 2007?

I was part of the team at Houston Methodist Hospital that searched the literature in 2007 and did not find any nursing articles about caring for patients with PAxIABPs. Medical journals had a few articles about similar procedures, but they focused on the surgical intervention with nothing about nursing care.

Since this was a relatively new procedure, the lack of nursing articles was not surprising. Our protocols were developed over time, using evidence-based nursing care and lots of “learning by doing.” After about 10 years of developing, reevaluating, and taking care of more than 100 patients with PAxIABPs who are awaiting heart transplant, our staff has become more competent and comfortable taking care of these patients.

Q: Explain how the nursing and medical teams collaborated to develop these protocols. Did you work together to determine what to try and what not to? Please explain.

The cardiologists informed us about the new procedure and what the change meant for the patients. They gave us parameters and guidelines on what to do and not to do to take care of the balloon pump and the insertion site. Overall, the doctors trusted the nursing staff to figure out how to walk these patients safely and provide the care needed at the bedside. The multidisciplinary team of nurses, doctors, physical therapists, and ancillary staff collaborated to devise interventions to mitigate the problems that arose and incorporate them into the standard of practice.  

Q: How did you decide how to develop and implement clinical practice guidelines if there was no previous literature with evidence-based practice backing it?

We did not have a choice. Our patients with intra-aortic balloon pumps needed us to find a way to get them moving. Our patients needed to walk to keep up their strength while waiting for a transplant, and we had to develop our own nursing care protocols based on existing evidence-based practices in order to safely incorporate walking and mobilizing into their care.

Q: What are the resulting clinical practice guidelines that reflect nursing care practice and patient treatment?

The mobility guidelines we developed address issues such as where patients walk within the cardiac care unit, for how far, and how long. We defined the number of staff who need to walk with the patient, based on each one’s individual strength. The guidelines also cover how often laboratory tests and x-rays need to be completed. For example, laboratory tests such as complete blood count and basic metabolic panel are obtained every other day to minimize blood loss and the need for blood transfusions. On the other hand, chest radiographs are obtained every day to determine the PAxIABP position.

Our nursing team also developed a PAxIABP repositioning kit so that transplant cardiologists can perform simple repositioning of the PAxIABP at the bedside as needed.  This kit contains sterile gloves, masks, surgical cap, stabilization device adhesive, CHG scrub stick, and a prepackaged central catheter dressing kit. The kit, stored in a clear plastic bag, is hung on a pole attached to the IABP console for easy access.

Q: The article lists some really interesting morale boosters used. Why are these so important to patients in these situations?

Our pre-heart transplant patients with IABPs wait anywhere from a few days to months for a donor heart. Anyone would get depressed with waiting for so long under such stress. So the nursing staff came up with different ways of helping our patients cope.

We consider these patients part of the CCU family and treat them as such. We call them by their first names, chat with them about anything and everything whenever we pass by their rooms, and get to know their family and other visitors. We celebrate birthdays, anniversaries, holidays, and other special occasions. We’ve found ways for patients to enjoy the occasional home-cooked meal, have their pets come for a visit, and more, in an effort to keep their spirits lifted.  

Our patients from 10 years ago regularly come to our unit when they are in town, chat with us, and offer to visit with current patients who might need a pep talk and some cheering up. Patients appreciate the extra effort we put into making their stay with us enjoyable.

Q: What else is important about the nursing protocols for patients with PAxIABPs?

We started with existing evidence-based practice, but our journey didn’t end there. Whenever a challenge arose, we found solutions to address the situation. We documented each lesson learned and worked through the unique challenges encountered with our patients. We gained confidence throughout this process in our ability to innovate and improve the care we provide to all of our patients. We hope that this article helps other nurses who are caring for patients with PAxIABPs or who may do so in the future. In addition, we hope it inspires nurses to trust in their abilities to be innovative and courageous as they strive to provide the best care for their patients.

To learn more about the protocols, visit https://www.aacn.org/newsroom/nurses-develop-protocols-for-patients-with-paxiabps.