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Feb 20, 2024

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1 Coronary Artery Disease Windy L. Tanner South University NSG 4055 Illness and Disease Management across Lifespan CP02 Professor Kara Bral MSN, RN March 29, 2022

2 Coronary Artery Disease Heart disease is the leading cause of death in the United States. Coronary artery disease (CAD) is the most common type of heart disease. CAD is a condition that affects the blood flow to the heart, leading to a heart attack. Heart disease may not be evident until signs and symptoms of a heart attack, heart failure, or arrhythmia occur in an individual. Heart failure can present with symptoms of shortness of breath, fatigue, lower extremity edema, distended neck veins, or ascites. Symptoms of a heart attack can be severe or mild and include discomfort to the arm, upper back, neck, or chest, heartburn indigestion, nausea or vomiting, dizziness, shortness of breath, or extreme fatigue. Arrhythmia causes an irregular cardiac rhythm presenting with palpitations or fluttering feeling in the chest (Benjamin et al., 2019). Health screenings and public education on risk factors and symptoms of heart disease are essential tools to implement in communities. The implementation will help increase heart disease awareness and decrease morbidity and mortality. Chronic health conditions such as heart disease have a devastating effect on society at the individual, local community, and national levels. CAD and Risk Factors The cause of coronary artery disease (CAD) is a collection of plaque in the walls of the arteries that supply blood to the heart and other parts of the body. Deposits of cholesterol and other sticky substances in the artery make up what is known as plaque. The plaque narrows the arteries over time and eventually leads to partial or total obstruction of blood flow. The plaque accumulation is known as atherosclerosis (Khot, 2003). The modifiable factors for CAD include obesity, poor physical activity, unhealthy eating, and tobacco use. Family history, ethnicity, and age are risk factors that cannot be modified (Nunn & Lambiase, 2011). Many health conditions, personal lifestyle choices, age, and genetics can increase the risk of heart disease. The CDC

3 reports that 47% of Americans have at least one risk factor for heart disease (Benjamin et al., 2019). Comorbidity and Morbidity Comorbidities associated with heart disease are hypertension, diabetes, hypercholesterolemia, and obesity. High blood pressure is a medical condition that can only be identified by monitoring blood pressure. It is a condition where the pressure of the blood in the arteries is too high and results in damage to the heart, brain, kidneys, and other organs in the body (Mohan et al., 2019). Treatment includes lifestyle changes and or medication to reduce the blood pressure. Hypercholesterolemia can only be identified with a blood test called a lipid panel to monitor the lipid levels in the blood. There are two primary components of screening the LDL and HDL. The LDL (low-density lipoprotein) is the bad cholesterol and causes plaque to build up inside the arteries. HDL (high-density lipoprotein) is considered good cholesterol, and higher levels offer some protection against heart disease (Benjamin et al., 2019). Medications, diet, and exercise can improve cholesterol levels. Diabetes mellitus is a medical condition in which the body does not produce enough insulin or cannot utilize the insulin to allow the glucose into cells to produce energy. Diabetes increases the risk of mortality in individuals with heart disease. Obesity is when an individual has an excess of body fat. Almost 70% of adult Americans are obese (Kones, 2011). Obesity is linked to hypercholesterolemia, hypertension, and diabetes. Regular preventive medical visits consist of screenings for these conditions by blood pressure monitoring, lab evaluations, weight monitoring, and education on unhealthy lifestyle choices. The best method to reduce heart disease is early identification and treatment with medications or lifestyle modifications. Lifestyle changes include increasing physical activity, changing eating habits, or stopping tobacco use (Nunn & Lambiase, 2011). Controlling blood pressure and

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4 glucose levels, lowering LDL levels, and maintaining a healthy weight is vital in decreasing heart disease. The Impact of CAD CAD is known as the “silent killer” and can weaken the heart muscle leading to heart failure. Heart failure is when the heart muscle is weak and cannot pump enough blood and oxygen to maintain homeostasis to the other organs in the body. In the United States, 6.2 million adults have heart failure, and it was mentioned in 2018 on 379,800 death certificates. It has an astronomical effect on the nation costing 30.7 billion dollars in 2012 to cover lost wages, medications, and other health care services. Risk factors for heart failure include CAD, diabetes, hypertension, obesity, valve heart disease, cardiomyopathy, congenital heart defects, atherosclerosis, peripheral arterial disease, pulmonary hypertension, and mental health disorders (Benjamin et al., 2019). Heart failure treatment consists of behavior modification to lifestyle habits and the addition of certain medications. In advanced heart failure disease, mechanical devices such as ICD implants, heart pumps, external life vests, or a heart transplant can be considered a treatment option for end-stage heart failure. Behavior modification includes changing dietary habits, increasing physical activity, decreasing sodium and water intake, monitoring daily symptoms, and monitoring daily weight and medication compliance (Sidney et al., 2022). Developing a patient-centered plan of care with goals decided by the patient improves results in a heart failure program. Heart failure is a costly medical condition with no cure, only management strategies to change outcomes and enhance patients’ quality of life. CAD is responsible for many premature cardiovascular disease (CVD) deaths. An increase in the low- and middle-income communities has been observed over the last decade. Patients with CAD report a significantly inferior health-related quality of life (HRQoL)

5 compared to other chronic diseases. Poorer HRQoL accompanies CAD due to different factors related to comorbid conditions. CAD is linked to more than one comorbid condition, usually associated with peripheral artery disease, cerebrovascular disease, or heart failure. The complexity of the individual’s health directly impacts other medical conditions such as depression and anxiety (Tušek-Bunc & Petek, 2016). The rise in CAD is related to the aging of America and unhealthy lifestyles in younger individuals; the relationship between an increase in CAD and the impact on the nation’s overall health is vast. The healthcare system has seen a growth in people less than 65 years of age hospitalized with heart failure, myocardial infarctions, and uncontrolled hypertension. The consequence is an increase in healthcare costs related to medications, hospitalizations, and other treatment therapies. The influence this has on the nation’s health is a decrease in work productivity for this group, lost wages, and a rise in disability due to a decline in heart function or heart damage from CAD or heart failure. CAD has a considerable impact on the nation’s financial and patient health, directly affecting the community. Goals and Objectives A multidisciplinary approach is necessary to treat this population to reduce hospitalizations. The team approach sets goals with the patient to obtain medication adherence, compliance with dietary restrictions, increased physical activity with cardiac rehab therapy, and counseling to evaluate for depression and effective coping mechanisms (Dibben et al., 2021). The long-term effects of a chronic condition can impact the individual in various ways. The patient may not be able to afford the medications, or insurance does not cover specific prescriptions, forcing them to choose between medication adherence and paying for utilities. Other impacts may be the availability of healthy food choices, the ability to participate in heart-

6 healthy exercise programs, or the ability to attend education classes or physician visits due to social determinants. Without the proper modifications and compliance to medications, diet, and exercise, the health of someone with CAD will not improve. Heart-healthy goals are imperative to include a patient-centered approach. Goals must align with the patients’ objectives and not be set by the healthcare provider. An assessment of health and wellness needs to be completed before initiating any care plan. A collaborative effort between the health care provider and patient occurs to support achievable goals. Heart-healthy goals can include an increase in physical activity. It will need to have a road map for integrating physical activity into the patient’s lifestyle. The plan must contain a consistent process for measuring physical activity and developing individualized, specifically tailored objectives using evidence-based programs as described in the American Journal of Health Promotion . Objectives will provide life skills to make healthier choices through empowerment strategies (Fulton et al., 2018). Using evidence-based behavior change techniques allows for education, motivation to occur, empowering patients to increase activity, improve dietary intake, and comply with medication adherence (Ecclestone & Jones, 2004). Medication adherence objectives aim to lower cholesterol levels, decrease blood pressure, and improve daily glucose checks or HA1C levels depending on comorbidities. Dietary changes with healthier food choices will reduce blood pressure, extremity edema, and fluid retention. The increase in physical activity aims to improve overall well-being, improve cardiac function, lower cholesterol, decrease blood pressure, and aid in weight loss. Objectives aligned with the patient-centered module have the most remarkable success rate for meeting the goals defined by the multidisciplinary team and patient. Yes/No Questionnaire for the Assessment of CAD Are you older than 65 years of age?

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7 Do you have a primary care provider (PCP)? If you have a PCP, do you schedule visits for healthcare issues when you feel sick? Do you complete routine annual wellness checks? Do you have annual lab work completed? Do you take any prescribed medications? Do you take other counter medications? If you take prescribed medications, do you have difficulty affording them? If you take prescribed medications, do you take them as prescribed? Do you follow a healthy heart diet (low in sodium, saturated fats, and high in fiber)? Do you eat alone? Do you prepare freshly cooked meals? Do you consume prepackaged foods more than one day a week? Do you dine at fast-food restaurants more than once weekly? Do you eat fried foods more than once weekly? In the last 30 days, were you able to afford balanced healthy meals? Do you use tobacco products? If you use tobacco products, would you like to stop? Have you been diagnosed with a medical condition? If yes to medical condition diagnosis, do you have more than one medical condition? Have you ever been told your blood pressure is high? Have you ever been told that your blood sugar level is elevated? Have you ever been told that your cholesterol is high? Do you know your lipid levels?

8 Do you monitor your blood pressure? Are you overweight? Do you monitor your weight daily? Do you have more than 3-pound weight gain in two days? Do you exercise for 30 minutes three days a week? Do you get short of breath performing activities of daily living? Do you sleep lying flat at night? Do you have to sleep elevated or with more than one pillow at night? Do you experience chest pain or discomfort when performing light physical activity? Do you experience chest pain or discomfort when performing moderate physical activity? Do you feel tired more than usual? Do you have a family history of heart disease? Conclusion Coronary heart disease is a chronic health condition that has no cure. Hypertension, DM, hypercholesterolemia, smoking, and obesity can lead to heart disease. These all are modifiable risk factors that can lead to heart disease. Early detection and treatment of hypertension, elevated cholesterol, and diabetes can help slow the progression of heart disease. Heart disease often goes undetected until advanced stages occur and an individual experiences a heart attack or the heart muscle becomes weakened, and the function is impaired. The burden of CAD is vast on the healthcare system with increased hospitalizations, readmissions, disabilities, and increased mortality. The care plan for CAD must be individualized and patient centered. Assessments conducted must include a holistic approach to developing a treatment plan. Goals and objectives must align with the individual’s wishes. Chronic health conditions like CAD accompanies other

9 comorbidities. Early identification, treatment with medications, education, and modifications to one’s lifestyle can reduce the incidence of CAD, improving the health of Americans.

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10 References Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., Delling, F. N., Djousse, L., Elkind, M. S., Ferguson, J. F., Fornage, M., Jordan, L., Khan, S. S., Kissela, B. M., Knutson, K. L.,...Virani, S. S. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation , 139 (10). https://doi.org/10.1161/cir.0000000000000659 Dibben, G., Faulkner, J., Oldridge, N., Rees, K., Thompson, D. R., Zwisler, A.-D., & Taylor, R. S. (2021). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews , 2021 (11). https://doi.org/10.1002/14651858.cd001800.pub4 Ecclestone, N. A., & Jones, C. (2004). International curriculum guidelines for preparing physical activity instructors of older adults, in collaboration with the aging and life course, world health organization. Journal of Aging and Physical Activity , 12 (4), 467–479. https://doi.org/10.1123/japa.12.4.467 Fulton, J. E., Buchner, D. M., Carlson, S. A., Borbely, D., Rose, K. M., O’Connor, A. E., Gunn, J. P., & Petersen, R. (2018). Cdc’s active people, healthy nationalism: Creating an active America, together. Journal of Physical Activity and Health , 15 (7), 469–473. https://doi.org/10.1123/jpah.2018-0249 Khot, U. N. (2003). Prevalence of conventional risk factors in patients with coronary heart disease. JAMA , 290 (7), 898. https://doi.org/10.1001/jama.290.7.898 Kones, R. (2011). Primary prevention of coronary heart disease: Integration of new data, evolving views, revised goals, and role of Rosuvastatin in management. A comprehensive

11 survey. Drug Design, Development and Therapy , 325. https://doi.org/10.2147/dddt.s14934 Mohan, S., Thirumalai, C., & Srivastava, G. (2019). Effective heart disease prediction using hybrid machine learning techniques. IEEE Access , 7 , 81542–81554. https://doi.org/10.1109/access.2019.2923707 Nunn, L. M., & Lambiase, P. D. (2011). Genetics and cardiovascular disease--causes and prevention of unexpected sudden adult death: The role of the sads clinic. Heart , 97 (14), 1122–1127. https://doi.org/10.1136/hrt.2010.218511 Sidney, S., Lee, C., Liu, J., Khan, S. S., Lloyd-Jones, D. M., & Rana, J. S. (2022). Age-adjusted mortality rates and age and risk–associated contributions to change in heart disease and stroke mortality, 2011-2019 and 2019-2020. JAMA Network Open , 5 (3), e223872. https://doi.org/10.1001/jamanetworkopen.2022.3872 Tušek-Bunc, K., & Petek, D. (2016). Comorbidities and characteristics of coronary heart disease patients: Their impact on health-related quality of life. Health and Quality of Life Outcomes , 14 (1). https://doi.org/10.1186/s12955-016-0560-1

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