Dean Patricia Davidson @nursingdean from  John Hopkins University’s School of Nursing @JHUNursing will be leading this week’s EBN Twitter Chat (#ebnjc) on Wednesday 15th July between 8-9pm UK time (3pm-4pm EDT) focusing on cardiovascular health as a global priority.

Participating in the Twitter Chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward:

• Go to your Twitter account
• Follow the discussion by searching for #ebnjc once linked to the discussion, click “all tweets” to keep up-to-date with recent tweets
• Add the EBN chat hash tag (#ebnjc) to your tweets to join in, this allows everyone taking part to view your contribution

Cardiovascular Health

Epidemiological transitions have signalled the need to not just focus on infectious diseases but also non-communicable diseases. This is a new paradigm in global health, which has traditionally been geared towards the management of infectious diseases. It has also expanded the roles of nurses and cast the spotlight on their important impact on health care from prevention to palliation.

Non-communicable diseases (NCDs) refer to health conditions or diseases that are non-infectious and non-transmissible. Of great significance to nurses is that many of these conditions can be prevented.

According to the Word Heath Organization, NCDs kill 38 million people each year, with 28 million of these deaths occurring in low and middle-income countries. Cardiovascular diseases account for most deaths from NCDS, or 17.5 million people annually, followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million).

Many of these conditions are chronic, complex and progressive, placing considerable burden on the individual, families, communities and society. As indicated above, cardiovascular disease is the NCD responsible for the most deaths worldwide, and much of this burden is attributable to heart attacks and strokes.

Yusuf and colleagues in the global INTERHEART study documented that nine easily measured risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, physical activity, alcohol consumption, and psychosocial factors) account for over 90% of the risk of acute myocardial infarction. This pattern of risk factors was the same across genders, racial and ethnic groups as well as geographic regions.   Although addressing these factors is overtly simple and low cost, many of us working in the field acknowledge that behaviour change is complex and moderated by physical, social, psychological and economic factors.  We also recognize we need positive policy environments to ensure health environments.

Knowledge is a necessary but insufficient condition for behaviour change but we have to engage society, individuals and providers more broadly to really create a context for a healthy environment.

Public health strategies, such as tobacco control, and boosting health infrastructure must form part of a multifaceted approach to this problem, in addition to an on-going focus on primary care.

Nurses play a critical role in the management of cardiovascular diseases across the health care continuum from prevention to diagnosis and death.  This requires a complex suite of knowledge, skills and values to advocate for the well-being of patients.  The importance of leadership is crucial for improving cardiovascular outcomes.  A range of competencies and skills is required for nursing to provide effective and efficient care. In addition to expert knowledge in cardiovascular care, nurses need to implement and evaluate evidence-based practice within culturally appropriate frameworks as well as advocating for patients and their families. .

Although cardiovascular diseases are preventable, they remain the most common cause of death in the world.

Most important is that although there have been some improvements in developed countries, many low-income and middle-income countries are experiencing a rapid increase in these conditions with limited infrastructure to both prevent and manage these conditions.

This emphasizes the need for crucial conversations to address cardiovascular health from the perspective of the health care system, individuals and health care providers.  Recognizing we live in a global world and our lives are intimately connected is a critical factor in ensuring cardiovascular health is a global priority. We look forward to your views and opinions in our twitter chat.

References

Anand, S. S., Islam, S., Rosengren, A., Franzosi, M. G., Steyn, K., Yusufali, A. H., … & Yusuf, S. (2008). Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. European Heart Journal, 29(7), 932-940.

Davidson, P. M., Meleis, A. I., McGrath, S. J., DiGiacomo, M., Dharmendra, T., Puzantian, H. V., … & Riegel, B. (2012). Improving women’s cardiovascular health: A position statement from the International Council on Women’s Health Issues. Health Care for Women International, 33(10), 943-955.

Lanuza, D. M., Davidson, P. M., Dunbar, S. B., Hughes, S., & Geest, S. D. (2011). Preparing nurses for leadership roles in cardiovascular disease prevention. European Journal of Cardiovascular Nursing, 10(2 suppl), S51-S57.