Best Practice for Assessing Cardiovascular Disease Risk in Asymptomatic Women 35-54 Years

Abstract

Session presented on Monday, September 19, 2016: Cardiovascular disease is the leading cause of death for women in the United States, as well as every major country. Unfortunately, disparities in cardiovascular health continue to be a significant public health issue. Although the United States has demonstrated a general decline in cardiovascular mortality over the past few decades, a number of population subgroups including educational background, ethnicity, geography, race, sex and socioeconomic status nevertheless demonstrate remarkable disparities in overall cardiovascular health (Mosca et al., 2011). The purpose of this EBP project was to determine the effect of cardiovascular screening after implementing and evaluating cardiovascular risk stratification and lifestyle modification. The implementation of this best practice was compared to current practice for women who were asymptomatic for coronary artery disease and between the ages of 35 and 54 years. The Stetler Model and Pender's Health Promotional Model facilitated the system change. The American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular (ACC/AHA ASCVD) Risk Estimator score was calculated on a single cohort of women between the ages of 35 and 54 at a medical clinic for the underserved in Northwest Indiana. The 2013 ACC/AHA Lifestyle Guideline was used to educate participants regarding therapeutic lifestyle changes. Paired-sample t tests were run to analyze the means of pre-scale data compared to post-scale data on each participant in the cohort (n= 34). Statistically significant differences were noted in four different variables. Results were statistically and clinically significant in modifiable risk factors including triglycerides (p = 0.043), weight (p = 0.006), and body mass index (p = 0.004). Marginal significant difference from pre-ASCVD lifetime risk score to post-ASCVD lifetime risk score (t(33) = 1.975, p = 0.05. In summary, this EBP project supported the best practice recommendation for assessing cardiovascular risk utilizing the ACC/AHA ASCVD Risk Estimator. This recommendation promotes primary and secondary prevention by identifying and targeting patients at increased risk for cardiovascular disease and improving patient outcomes. In conclusion, primary and secondary prevention must start as early as age 21 years in order to make a dramatic impact on CV risk (Lopez-Jimenez et al., 2014). After actively engaging with each patient in order to screen respective cardiovascular risk, the patient understands his or her individual modifiable risk factors. As a result, healthcare providers can empower their patient to adapt healthy lifestyles. As healthcare providers, engage the conversation, and construct the change to make a difference toward a healthier population for 2020. References Chomistek, A. K., Chiuve, S. E., Eliassen, A. H., Mukamal, K. J., Willett, W. C., Rimm, E. B.(2015). Healthy lifestyle in the primordial prevention of cardiovascular disease among young women. Journal of the American College of Cardiology. 65(1), 43-51. doi: 10.1016/j.jacc.2014.10.024 Eckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Miller, N. H., Lee, I. M., & . . . Yanovski, S. Z. (2014). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63(25), 2960-84. doi:10.1016/j.jacc.2013.11.003 Goff, D. J., Lloyd-Jones, D. M., Bennett, G., Coady, S., D?Agostino, R. B., Gibbons, R., & . . . Tomaselli, G. F. (2014). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal ofAmerican College of Cardiology,63(25), 2935-2959. doi:http://dx.doi.org.10.1016/j.jacc.2013.11.005 Lopez-Jimenez, F., Simha, V., Thomas, R. J., Allison, T. G., Basu, A., Fernandes, R., & . . .Wright, R. S. (2014). A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Filling the Gaps. Mayo Clinic Proceedings,89(9), 1257-1278. Mosca, L., Benjamin, E. J., Berra, K., Bezanson, J, L., Dolor, R. J., Loyd-Jones, D. M., & . . . Wenger, N. K. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: A guideline from the American Heart Association. Journal of the American College of Cardiology, 57(12), 1404-1423. doi:10.1016/j.jacc.2011.02.005