AANP Member Spotlight: Recognizing American Heart Month All Year-round

While February is deemed American Heart Month, AANP Fellow Colleen Walsh-Irwin, DNP, RN, ANP-BC, AACC, FAANP, shares tips on how to heighten awareness and make a positive difference for patients throughout the year.

In the United States, heart disease, stroke and other cardiovascular diseases are the cause of one in three deaths each year, according to the Centers for Disease Control and Prevention (CDC). This equates to $214 billion annually in health care costs and amounts to $138 billion in lost productivity from premature death alone.

To help combat the impact of heart disease in the U.S., Million Hearts® 2022, a nationwide initiative co-led by the CDC and the Centers for Medicare and Medicaid Services (CMS), aims to prevent 1 million heart attacks and strokes within five years. Its goals include:

• Keeping people healthy by reducing sodium intake, decreasing tobacco use and increasing physical activity.
• Optimizing health care by encouraging appropriate aspirin and statin therapy usage, controlling high blood pressure, ensuring adult tobacco users receive counseling and helping eligible patients participate in cardiac rehabilitation.
• Focusing on high-priority populations, including Black or African American people with high blood pressure, people who have had a heart attack or stroke and people with mental or substance use disorders who use tobacco products.

“Cardiology is well suited for nurse practitioners [NPs]. As NPs, we look at the whole patient and the whole family when providing care,” says Dr. Walsh-Irwin, an NP and program manager of evidence-based practice at the Department of Veterans Affairs (VA). “I think one of the biggest assets of NPs is that we have a passion for educating patients. So much of what we do to treat patients as a whole person involves listening to them and educating them about why a medication is important, for example, or explaining the research. Advocating for them is based in research and staying on top of the most up-to-date information.”

Heart Health and COVID-19

Dr. Walsh-Irwin notes that people with heart conditions — such as heart failure, coronary artery disease and cardiomyopathies — are at a higher risk of contracting severe illness from SARS-CoV-2. Obtaining the COVID-19 vaccine as soon as patients are able is extremely important. However, the pandemic has also led to a rise in additional barriers for patients.

“During the COVID-19 pandemic, we’ve unfortunately seen that many patients have died because they didn’t seek immediate medical attention for a heart disease-related issue,” says Dr. Walsh-Irwin. “I convey to patients that a heart attack won’t just go away. I always say, ‘time is tissue.’ Even as we face COVID-19, it’s still important to seek emergency care should you experience symptoms.”

Similarly, she says, there was a reduction in the number of bypass surgeries conducted last year, and many patients chose to delay routine testing: “Untreated heart disease or high blood pressure can lead to things like heart attacks or congestive heart failure. Care should be sought as soon as possible to reduce the chance of long-term effects.”

In addition to medication, exercise is an important component of how heart disease is treated; however, the COVID-19 pandemic has also led to a decrease in physical activity for many Americans. “People have stopped going to gyms and many have shared that they are afraid of even going for a walk. As providers, we need to impress upon people that it’s still important to meet physical activity recommendations,” Dr. Walsh-Irwin says.

Strategies she has recommended to patients include encouraging them to walk around their homes — sometimes even around their kitchen islands — or splitting up a 20-minute walk into five-minute stretches throughout the day. “Like every other lifestyle change, physical activity is a habit that takes work to become consistent,” Dr. Walsh-Irwin says. “Exercise can make such a dramatic improvement in patients’ heart health that even a little activity is better than nothing.”

The NP’s Role in Cardiology

NPs are at the forefront of caring for patients all the way from preventive health care to palliative care. “In the cardiology field, NPs perform diagnostic testing as well as care for patients affected by arrhythmias, coronary artery disease, valvular disease, heart failure and more,” says Dr. Walsh-Irwin.

A recent quality improvement report published in the Journal of the American Association of Nurse Practitioners (JAANP) supports the NP role in cardiology. An NP-led, multidisciplinary heart failure clinic aimed to reduce 30-day, all-cause readmissions — and the results were a reduction in the readmission rate, an increase in the number of patients seen, a decrease in the number of days between discharge and follow up and higher patient satisfaction rates.

Dr. Walsh-Irwin shares that NP students who are interested in practicing within the cardiology field should understand their practice setting requirements and, whenever feasible, complete clinical hours in a cardiology practice. For practicing NPs looking to switch to cardiology, it’s important to develop relationships with the cardiologists and cardiology practices to whom you refer — and to get involved in stress tests and other diagnostic tests.

“NPs are also looking at patients’ social determinants of health,” she adds. “We know that treatment recommendations may be affected by race or ethnicity. Women may experience different heart attack symptoms than men, and are often excluded from research studies, so we need to ensure that their questions are heard and that they are properly informed. Gaining an understanding of a patient’s diet can help us partner with patients to coach them toward a healthier lifestyle.”

Cardiology Resources for Your Patients

Million Hearts offers tools, educational materials and data to support your practice, such as:

• Data on the potential future burden of cardiovascular events, which Million Hearts aims to improve upon, and on the initiative’s progress updates.
• Toolkits, resource guides, evidence-based protocols and patient education packets to assist clinicians in motivating and monitoring patients.
• A COVID-19 and Cardiovascular Disease Partner Toolkit, which includes social media messages, videos, graphics and other resources from the CDC’s Division for Heart Disease and Stroke Prevention to encourage patients to seek out cardiovascular care safely during the pandemic.
• Fact Sheets, including the ABCS of Heart Health:
  
  • Take aspirin as directed.
  • Control blood pressure.
  • Manage cholesterol.
  • Don’t smoke.

As a co-chair for the AANP Cardiology Specialty Practice Group (SPG), Dr. Walsh-Irwin also invites any AANP member interested in cardiology to join, participate in discussions and gain support from other practicing NPs. “There are individuals on the forum who are superstars in the field and who are incredibly knowledgeable,” she says.

Dr. Walsh-Irwin also says that she cannot imagine being an NP in the U.S. and not being a member of AANP: “The wealth of information provided is essential — the support for pro-NP legislation and policies, the networking and continuing education (CE) opportunities, the clinical practice guidelines, the e-newsletters and much more. AANP is a voice for all NPs.”

By becoming a member of AANP, you also have access to the AANP CE Center, which offers cardiology activities such as:

• Current and Future State of Cardiovascular Disease and Type 2 Diabetes — This multimodule CE activity addresses the optimal management of Type 2 diabetes in the context of cardiovascular disease.
• The Essentials: Managing Hypertension in Primary Care — This activity addresses the 2017 clinical Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults.
• Diagnosing and Managing Ischemic Cardiogenic Shock in Adult Patients: Essentials for Nurse Practitioners in Emergency Department, Acute and Critical Care Settings — This activity provides NPs in emergency, acute and critical care settings an evidence-based approach for clinical decision-making, including pharmaceutical and non-pharmaceutical management of adult patients with suspected and confirmed ischemic cardiogenic shock.
• Heart Failure with Reduced EF: Acute and Chronic Management in the Ambulatory Setting — This activity focuses on the management of heart failure with reduced ejection fraction in both the stable and acute phases of illness in the ambulatory setting.