All about cardiovascular nursing
Shared by: cardiovascularnuse
Journal of Cardiovascular Nursing Vol. 28, No. 2, pp 103Y105 x Copyright B 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Progress in Prevention Calling all Cardiovascular Nurses: Be One in a Million Hearts Million Hearts Initiative Cheryl R. Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN; Laura L. Hayman, PhD, RN, FAAN T he Million Hearts is a national initiative to prevent 1 million myocardial infarctions and strokes efforts, as well as creates new pro- grams, to improve health across communities and help Americans technology (HIT) to report and improve ABCS performance, and in- novating care delivery to improve over 5 years by focusing the nation live longer, more productive lives. adherence and control of ABCS.1 on evidence-based community and The Centers for Disease Control Current performance on Million clinical prevention actions.1,2 Million and Prevention (CDC) and Centers HeartsYrelated measures varies widely Hearts brings together communities, for Medicare & Medicaid Services across clinical systems, from well be- health systems, nonprofit organiza- (CMS) co-lead Million Hearts within low 50% to nearly 90%.1 With this tions, federal agencies, and private- the Health and Human Services. information in mind, the goals for sector partners from across the Key components of the initiative performance on the Million Hearts country to make a long-lasting im- emphasize cardiovascular health and measuresinhealthcaresettingswereset pact against cardiovascular disease.2 include community prevention to re- at 70%, rather than at an unrealistic Launched by the Department of duce the number of people who need or potentially harmful 100% (Table).1 Health and Human Services in treatment and clinical prevention to Million Hearts brings together a September 2011, it aligns existing optimize care for those who do re- number of programs, policies, and quire care.2 Community prevention campaigns designed to make a pos- Cheryl R. Dennison Himmelfarb, strategies aim to reduce the number itive impact across the spectrum of PhD, RN, ANP, FAHA, FPCNA, FAAN Associate Professor, Department of Acute of people who need treatment, such prevention and care, promoting the and Chronic Care, Johns Hopkins University as blood pressure or cholesterol med- ABCS of clinical prevention as well School of Nursing, and Division of Health ications, to prevent myocardial in- as healthier lifestyles and commu- Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland. farctions and strokes by empowering nities.2 Some of Million Hearts’ Laura L. Hayman, PhD, RN, FAAN Americans to make healthier choices wide-ranging activities include (1) Associate Dean for Research, Professor of by preventing tobacco use and limit- educational campaigns to increase Nursing, College of Nursing and Health ing sodium and trans-fat consump- awareness about heart disease pre- Sciences, University of Massachusetts Boston, and Director of Research, GoKids, tion. Clinical prevention efforts to vention and empower patients to Boston, Massachusetts. improve quality of care focus on take control of their heart health, The authors have no funding or conflicts of the ABCSVaspirin for people at (2) use of HIT and quality improve- interest to disclose. risk, blood pressure control, cho- ment initiatives to standardize and Correspondence lesterol management, and smoking improve the delivery of care for Cheryl R. Dennison Himmelfarb, PhD, RN, ANP, FAHA, FPCNA, FAAN, Department of cessationVwhich address the major high blood pressure and high cho- Acute and Chronic Care, Johns Hopkins risk factors for cardiovascular dis- lesterol, and (3) community efforts University School of Nursing, Division of ease and can help to prevent myo- to promote smoke-free air policies Health Sciences Informatics, Johns Hopkins University School of Medicine, 525 N cardial infarctions and strokes.2 and reduce sodium in the food sup- Wolfe Street, Rm 527, Baltimore, MD Strategies include aligning care goals ply. Toolkits were designed to help 21205-2110 (firstname.lastname@example.org). with provider and system incentives, partners incorporate Million Hearts DOI: 10.1097/JCN.0b013e3182819dcc fully deploying health information into their everyday work and enhance 103 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 104 Journal of Cardiovascular Nursing x March/April 2013 TABLE Benchmarks for Million cruit others to improve clinical the Million Hearts partner orga- Hearts Program Success1,2 preventive practice and commu- nizations are highlighted. Detailed nity prevention. The Grand Rounds progress notes are provided on se- Measure 2017 Goal Toolkit features CDC Director Dr lect successful projects chosen based Aspirin use for people 70% Tom Frieden, Million Hearts Ex- on their potential for implementa- at high risk ecutive Director Dr Janet Wright, tions by other organizations. The Blood pressure control 70% Cholesterol (LDL-C) 70% and CMS Chief Medical Officer selection criteria include their ef- management Dr Patrick Conway talking about fectiveness, how easily they can be Smoking cessation 70% the initiative’s focus on preventing replicated, and their inclusion of les- Sodium intake (average) 20% reduction myocardial infarctions and strokes sons learned.2 The American Heart Artificial trans fat 50% reduction through clinical preventive prac- Association/American Stroke Asso- consumption (average) tice and community prevention with ciation has also joined forces with Abbreviation: LDL-C, low-density lipoprotein first-person accounts from 2 commu- Million Hearts providing tools in- cholesterol. nities working to create healthier cluding the Heart Attack Risk Cal- environments and to align health- culator, My Life Check, and Life’s their heart disease and stroke pre- care professionals and systems to Simple 7. Other tools include videos vention efforts. 2 They include improve quality of care. The Blood with personal stories about heart messages for consumers and health- Pressure Toolkit was designed to be disease and stroke prevention. care professionals and tools to used with patients to help address Nurses, other healthcare pro- support local events. A Partners high blood pressure in your clinics viders, and health systems are vital Toolkit, Grand Rounds Toolkit, and and communities. to the Million Hearts mission. Spe- Blood Pressure Toolkit are available In addition, the Million Hearts cific actions to promote the goals for download and use in full or as Web site provides numerous re- of this ambitious initiative are listed individual components.2 The Part- sources to support community and in the Box. ners Toolkit can be used to expand clinical prevention of heart disease Preventing 1 million myocardial existing heart disease and stroke and stroke. Successes and best prac- infarctions and strokes in 5 years prevention programs and to re- tices in heart disease and stroke by will require commitment to change Box. Actions to Advance Million Hearts Focus on the ABCS with your patients Prioritize control of high blood pressure and cholesterol. Help your patients follow treatment instructions and improve medication adherence. Ask your patients about their smoking habits and provide smoking cessation counseling and tools for smokers. Prescribe appropriate aspirin therapy for those who would benefit. Track and improve ABCS performance through HIT and quality improvement Report on the ABCS-related Cardiovascular Prevention Measures Group in the CMS Physician Quality Reporting System. Use HIT, such as electronic health records with clinical decision support tools and a patient registry, to improve the delivery of care for ABCS in patients and populations/panels. For example, use electronic health record registry functionality regularly to detect those with uncontrolled hypertension or cholesterol and recall them for follow-up. Align provider education and quality improvement initiatives to focus on and improve ABCS. Recognize and reward healthcare providers who address and promote ABCS in their patients. Connect with other clinicians in your community in a learning and action network aimed at improving ABCS in your patients. Support team-based approaches to care to improve coordination and quality of care for patients. Implement innovative care models (patient-centered medical homes, accountable care organizations) that include a focus on the ABCS. Connect at-risk patients with community resources for self-management, diabetes education, and other community resources to address barriers to adherence. Decrease health disparitiesVuse culturally appropriate education materials, patient navigators, community health workers to address barriers to care. Educate your patients and community about the most effective ways to control their risk factors for heart disease and stroke. Promote heart-healthy habits to your patients, such as regular physical activity and a diet rich in fresh fruits and vegetables. Reduce out-of-pocket costs for smoking cessation, blood pressure, and cholesterol medications and services. Drive awareness of the initiative. Include Million Hearts messages in newsletters, pledge your organization’s commitment on the Million Hearts Web site, and recruit at least 20 patients and partners to do the same. Convene partners, stakeholders and policy makers for Million Hearts events. Share success stories on the Million Hearts Web site. Monitor whether progress is being made in your community. Adapted from the Million Hearts CDC Grands Rounds Toolkit.3 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. The Million Hearts Initiative 105 not only in the cardiovascular about Million Hearts, visit http:// 2. Centers for Disease Control and Pre- vention. Million Hearts. http://million health behaviors of the nation but millionhearts.hhs.gov.2 hearts.hhs.gov. Accessed December 4, also in our cardiovascular health 2012. promotion and risk factor man- REFERENCES 3. Centers for Disease Control and Pre- agement practices. Each of us can 1. Wright JS, Wall HK, Briss PA, vention. Million Hearts CDC Grand Schooley M. Million HeartsVwhere Rounds Toolkit. http://millionhearts.hhs be 1 in a Million Hearts, taking ac- population health and clinical prac- .gov/Docs/GR_Toolkit/Grand_Rounds_ tion and making a positive impact tice intersect. Circulation. 2012;5: toolkit.pdf. Accessed December 4, toward this goal. To learn more 589Y591. 2012. Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.