Case Management of Coronary Artery Disease in the Lee ...



Case Management of Coronary Artery Disease in the Lee County Community

Sarah Moore, Elizabeth Nielsen, Erika Strother, and Stephanie Works

Auburn University School of Nursing

Introduction

“Coronary artery disease (CAD) is the most common type of heart disease and is the leading cause of death in the United States in both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material such as plaque. This buildup is called atherosclerosis. As the buildup grows, less blood can flow through the arteries. As a result, the heart muscle can no longer get the blood or oxygen it needs” (U.S. National Library of Medicine, 2010). The purpose of this paper is to provide detailed information on the coronary artery disease process and implement a primary prevention intervention program for this disease with the target population being Lee County. Lee County Community Assessment The community that is assessed within this paper is Lee County, Alabama, which is then further divided into Auburn and Opelika. Lee County is located in East Central Alabama and encompasses 609 square miles. Auburn is the largest city in Lee County and is home to Auburn University. Auburn is considered an urban area, because the population exceeds 1,000 people per square mile (U.S. Census Bureau, 2009). The city of Auburn community profile notes that the total population of Auburn is 51,906 people, and the population of Opelika is 23,498 people (U.S. Census Bureau, 2000). Among the Lee County population, 50.7% of the residents are female with the remaining 49.3% being male. The racial profile of the county is as follows: 73.2% White, 23.6% Black, 0.3% American Indian, 2.0% Asian, and 2.2% Hispanic. The median household income is $41,770, and 15.5% of the residents are below poverty level (US Census Bureau, 2009).

The Auburn/Opelika area contains numerous health-related resources that are available to the residents in this area. These include numerous pharmacies located not only in drug stores, but also grocery stores and clinics as well. Auburn University offers a pharmacy for its employees, dependents, and retirees, which is located on the Auburn University Campus. The area also contains many doctors’ offices, and East Alabama Medical Center, which services Lee County as a whole. East Alabama Medical Center (EAMC) offers an extremely wide variety of services including ambulance, cancer, cardiology, childbirth, critical care, surgery, imaging, psychiatric, and emergency services. EAMC is accessible to the general public and anyone is eligible to utilize the hospital services. In addition to the services that the hospital provides the community, EAMC also offers rehabilitation facilities in Lee County including inpatient rehabilitation at EAMC and RehabWorks. EAMC also owns most of the hospice and home health facilities in Lee County, which include Hospice of EAMC and HomeMed (East Alabama Medical Center,

2010). 

Aside from pharmacies, clinics and EAMC facilities, The Alabama Department of Human Resources offers a number of services including adult care services, childcare services, family services, and family assistance. The Lee County Department of Human Resources is located on Corporate Drive in Opelika and offers family and child services, child support information, and food assistance information (Alabama Department of Human Resources, 2010).  Health Statistics In America, coronary heart disease was responsible for 616,067 deaths in 2007 and is the single leading cause of death today (Center for Disease Control and Prevention, 2007). Within Lee County in 2008, 209 deaths were caused by heart disease. Of these 209 deaths, 102 of them were male and the remaining 107 were female. One hundred fifty-two of these deaths were of the white race and 57 were black or other races (Alabama Department of Public Health [ADPH], 2008). Among heart disease in Lee County, the largest number of deaths is related to ischemic heart diseases. Below is the breakdown of these deaths by sex and selected causes of ischemic heart disease.

|Cause of Death |Total |White |Black & Other |

| | |Male |Female |Male |Female |

|Acute myocardial infarction |70 |31 |17 |13 |9 |

|Other acute ischemic heart diseases |1 |0.8 |0 |1 |0 |

|Other forms of chronic ischemic heart disease |44 |16 |16 |4 |8 |

|Atherosclerotic CV disease |4 |1 |1 |1 |1 |

|All other forms of chronic ischemic heart disease |40 |15 |15 |3 |7 |

(Alabama Department of Public Health, 2008)

In Alabama, more than one out of four deaths are caused by heart disease (Center for Disease Control and Prevention, 2007). This correlates to 12,583 Alabaman deaths from heart disease in 2006, which accounted for 26.8% of the total deaths in Alabama. In the United States, coronary heart disease death rates per 100,000 people were 176.3 for white males and 206.4 for black males; and 101.5 for white females and 130.0 for black females in 2006. This year alone, an estimated 1.26 million Americans will have a new or recurrent coronary attack (American Heart Association, 2010).

The Behavioral Risk Factor Surveillance System (BRFSS) completed a survey investigating the risk factors relating to Heart Disease in strokes within Alabama and then compared them to the correlating statistics for the United States (Center for Disease Control and Prevention, 2001). The results are in the following table:

|Risk Factor |Alabama |Nationwide (States and D.C.) |

|Eat fruits and vegetables less than 5 times/day |79.4 |75.6 |

|Overweight or obese |66.6 |62.9 |

|No moderate or vigorous exercise |58.3 |50.5 |

|High total blood cholesterol |39.4 |37.6 |

|High blood pressure |33.1 |27.8 |

|Cigarette smoking |22.5 |19.8 |

|Diabetes |10.3 |8.0 |

(Center for Disease Control and Prevention, 2001)

Healthy People 2010 Goals and Objectives Healthy People 2010 has six goals relating to coronary heart disease. The first goal is to reduce the number of coronary heart disease deaths nationwide. Their target goal is 166 deaths per 100,000 populations, and their baseline in 1998 was 208 deaths per 100,000, which was adjusted to the 2000 year standard population. The target setting method is to see a 20% improvement (Healthy People 2010, 2010). The following table outlines demographics of the baseline population for these goals.

|Total Population, 1998 |Coronary Heart Disease Deaths |

| |Rate per 100,000 |

|TOTAL |208 |

|Race and ethnicity |

|American Indian or Alaska Native |126 |

|Asian or Pacific Islander |123 |

|Asian |DNC |

|Native Hawaiian and other Pacific Islander |DNC |

|Black or African American |252 |

|White |206 |

|  |

|Hispanic or Latino |145 |

|Not Hispanic or Latino |211 |

|Black or African American |257 |

|White |208 |

|Gender |

|Female |165 |

|Male |265 |

|Education level (aged 25 to 64 years) |

|Less than high school |96 |

|High school graduate |80 |

|At least some college |38 |

|Disability status |

|Persons with disabilities |DNC |

|Persons without disabilities |DNC |

DNC= Data Not Collected (Healthy People 2010, 2010)

The second overall goal of Healthy People 2010 is to increase the proportion of adults aged 20 years and older who are aware of the early warning signs and symptoms of a heart attack and the importance of accessing rapid emergency care by calling 911. The third is to increase the proportion of eligible patients with heart attacks who receive artery-opening therapy within an hour of symptom onset. Goal number four is to increase the proportion of adults aged 20 years and older who call 911 and administer cardiopulmonary resuscitation (CPR) when they witness an out-of-hospital cardiac arrest. Fifth, they want to increase the proportion of eligible persons with witnessed out-of-hospital cardiac arrest who receive their first therapeutic electrical shock within 6 minutes after collapse recognition. And lastly, it is vital to reduce hospitalizations of older adults with congestive heart failure as the principal diagnosis (Healthy People 2010, 2010). The final goal also outlines a specific target and baseline which is shown in the table below.

|Objective |Reduction in Hospitalizations of Older Adults |1997 |2010 |

| |With Congestive Heart Failure as the Principal |Baseline |Target |

| |Diagnosis | | |

| | |Per 1,000 Population |

|12-6a. |Adults aged 65 to 74 years |13.2 |6.5 |

|12-6b. |Adults aged 75 to 84 years |26.7 |13.5 |

|12-6c. |Adults aged 85 years and older |52.7 |26.5 |

(Healthy People 2010, 2010)

Within Lee County, there are numerous resources available to the coronary artery disease population. One amazing resource is the cardiopulmonary rehabilitation center at East Alabama Medical Center. This facility is outpatient exercise and tertiary prevention program to speed your recovery and educate you in lifestyle choices that build and maintain a healthy heart. The staff within this facility is available to assist in obtaining a physician referral necessary to participate in this program (EAMC, 2010). In addition to the rehabilitation services provided by EAMC, they also provide surgical services related to coronary artery disease such as cardiac catheterization, coronary artery bypass graft services and many others (EAMC, 2010). In addition to EAMC services, Auburn Housing Authority offers free weekly screenings on heart rate, blood pressure, weight, and cholesterol. This is an easily accessible resource for a wide array of the Lee County population to utilize consistently. Also, Lee County alone offers over eleven private cardiologist services. A list of these physicians can be obtained through the EAMC website under “Find a Physician” (EAMC, 2010). The Lee County Department of Public Health also offers serviced related to coronary artery disease and heart health. The cardiovascular health (CVH) branch of the health department “provides education on the importance of controlling high blood pressure and high blood cholesterol, calling 9-1-1 immediately upon recognition of a heart attack or stroke, and recognizing the signs and symptoms of a heart attack or stroke. The CVH Branch also works to raise awareness, improve the quality of heart disease and stroke care and facilitate change in high risk communities in Alabama no matter one's race, ethnicity, gender, geography, or socioeconomic status” (ADPH, 2010).

The community nursing diagnoses for Coronary Artery Disease in Lee County are as follows:

• Risk for knowledge deficit regarding CAD among Lee County related to inadequate understanding of the disease process.

• Risk for altered nutrition more than body requirements among Lee County related to knowledge deficit regarding heart healthy diet.

• Risk for impaired circulation among Lee County related to atherosclerotic disease.

• Ineffective tissue perfusion among Lee County related to diagnosis of coronary artery disease.

• Risk for activity intolerance among Lee County related to ineffective cardiac output secondary to coronary artery disease.

Patient Detailed Case History

The patient selected for this project is a fifty-seven year old Caucasian male who came to the hospital on August 30, 2010 with a history of heart disease. He reported having increased chest pressure for the past month lasting anywhere from fifteen to forty minutes accompanied by diaphoresis and nausea. Also, the patient has a history of type 1 diabetes, hypertension, hypercholesterolemia, coronary artery disease, and angina. His surgical history includes a knee arthroscopy and a coronary artery stent implanted in 2001. The patient admits that he stopped smoking in 2001, but previously smoked for about twenty years. He also admits to drinking three to four alcoholic beverages a day.

Upon admission he underwent a stress test. This stress test was positive, which further lead him to undergo a cardiac catheterization procedure. This demonstrated that he had severe three-vessel disease with an ejection fraction of about 45 to 50%. Because of his situation, the patient was scheduled to undergo surgery the next day to repair the problem. The surgery resulted in the patient having a coronary artery bypass graft times five. In a report given by the cardiovascular surgeon the details of the arteries involved are as follows: He had a left internal mammary artery to a left anterior descending artery, a saphenous vein graft to a right posterior descending artery, a saphenous vein graft sequential to an obtuse marginal artery and a ramus artery, and a saphenous vein graft to a diagonal artery. The following day after surgery he was doing well and was able to be transferred from the cardiovascular intensive care unit (CVICU) to the step-down unit where he stayed for three days and was then discharged home. At discharge, the patient was given a referral, by the physician, to attend cardiac rehab at East Alabama Medical Center.

Management and Treatment of Coronary Artery Disease Case management for coronary artery disease (CAD) patients is important because CAD is the single most common cause of death in the developed world. Out of all the people with CAD, 9.8 million have angina pectoris and nearly 8 million have had a myocardial infarction (MI) (Cassar et al., 2009). The morbidity, mortality, and socioeconomic importance of this disease make timely accurate diagnosis and cost-effective management of CAD very important (Choudhry & Winkelmayer, 2008). Imaging modalities, pharmacological treatment, and invasive (percutaneous and surgical) interventions have revolutionized the current treatment of patients with CAD. Medical treatment remains the cornerstone of management, but revascularization continues to play an important role (Cassar et al., 2009).

The estimated direct and indirect economic cost of CAD in the United States from

2009 was $165.4 billion. Worldwide, cardiovascular disease is becoming pandemic as developing countries experience the epidemiologic transition. Mortality from cardiovascular disease is predicted to reach 23.4 million in 2030. In the developing world, cardiovascular disease tends to affect people at a younger age, which could negatively affect the workforce and economic productivity (Cassar et al., 2009).

Chronic stable angina, the initial manifestation of CAD in approximately 50% of all patients, is usually caused by the obstruction of at least one large epicardial coronary artery by

atheromatous plaque. Management of CAD has two main goals: to reduce symptoms and ischemia and to prevent MI and death. Medical management is a priority in all patients with CAD. The first step is to identify and treat any associated diseases that can precipitate angina by increasing myocardial oxygen demand (such as tachycardia and hypertension) or by decreasing the amount of oxygen delivered to the myocardium (such as heart failure, pulmonary disease, or anemia). The second step is to manage CAD risk factors as well as to prevent MI with lifestyle changes and pharmacological treatment (Cassar et al., 2009). Medications commonly used to manage CAD include beta-blockers, lipid lowering agents, nitrates, angiotension converting enzyme (ACE) inhibitors, and aspirin. These drugs have been estimated to reduce CAD mortality by 80% (Choudhry & Winkelmayer, 2008).

The indications for coronary revascularization continue to evolve and the benefits of coronary revascularization in reducing cardiac events and death have been widely accepted (Cassar et al., 2009). Two methods of revascularization are well established for CAD: coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). PCI includes percutaneous balloon angioplasty and stenting with bare metal or drug-eluting stents. The CABG procedure is often the preferred method of revascularization in patients with multivessel coronary disease (Yang et al., 2007). A criterion for multivessel disease includes three or more diseased vessels (Cassar et al., 2009). When comparing both methods of revascularization, the PCI procedure usually treats only the focal area of the most significant occlusion where as a CABG will bypass the plaque that could potentially develop into culprit lesions over time (Yang et al., 2007). All of the above treatment and management strategies are recommended from evidence-based practice.

Practice Guidelines for Coronary and Vascular Disease Using evidence based research, the American Heart Association (AHA) has developed guidelines for secondary prevention for patients with coronary and other vascular diseases. The main topics for the guidelines include smoking cessation, blood pressure control, lipid management, physical activity, weight management, diabetes management, antiplatelet agents and anticoagulants, rennin-angiotension-aldosterone system blockers, beta- blockers, and the influenza vaccination. Each patient should have complete smoking cessation and should receive education about tobacco use. Patient’s blood pressure goal should be less than140/90, and if they have diabetes or chronic kidney disease their goal should be less than 130/80. Goals for lipid management are a low-density lipoprotein (LDL) of less than 100 mg/dL, a non high-density lipoprotein (HDL) of less than 130 mg/dL if triglycerides are greater than or equal to 200 mg/dL. Patients should have at least thirty minutes a day of exercise every day of the week. Weight goals are a body mass index between 18.5 and 24.9 kg/m2. Women’s waist circumference should be less than 35 inches and men’s waist circumference should be less than 40 inches. All diabetic patients goal is to have a hemoglobin A1c less than seven percent. All of these patients should also receive antiplatelet and anticoagulant agents, renin-angiotensin-aldosterone system blockers, and beta-blockers. They should all also receive the influenza vaccination (Smith et al., 2006). Practice Guidelines Compared with Received Patient Care The patient selected for the project received almost everything under the AHA guidelines. He no longer smokes but did receive information on the importance of smoking cessation and the effects of tobacco on the body. He has a history of hypertension but it is being controlled by medication. The patient also has a history of hypercholesterolemia and it is also being controlled by medication. He was educated on the importance of daily exercise and the difference types of exercise that would benefit him the most. Currently, the patient is not overweight but was instructed on the waist measurement he should maintain. He does have type 1 diabetes, which is currently controlled, but he was also educated on the importance of diabetes management and the possible complications of non-management. In addition, the patient received all of the medications listed in the practice guidelines. The one thing he did not receive in the hospital was the influenza vaccine.

Cost Analysis of Client Care

After reviewing the patient’s hospital bill, no charges seemed out of the ordinary for a typical CABG patient. Our patient’s total operating room service charge for his CABG procedure was $8,932.50. The charge was originally $7,620.00, but an extra $1,312.50 had to be added for the length of the procedure taking longer than normal. If the extra money had not been added, the original amount of $7,620.00 would have been less than a $1,000 away from the average base price in the United States for a CABG procedure, which is $6,650.00 (SurgeryPlanet, 2006). After analyzing the patient’s bill, there were no double charges for supplies, no unnecessary or extra supply charges, and all of the medications listed are appropriate medications for this patient. When looking at a patient’s hospital bill, nursing care will not be found in the charges. This care is simply added under the room charge; therefore, it must be looked at closely and subtracted from the total room charge. The total room charge for this patient was $1,363.00. The average national hourly rate for a registered nurse (RN) is $22.07 - $30.75 per hour (PayScale, 2010). If the lower end of that range is taken and multiplied by a 24-hour period this would give a total of $529.68 for nursing care charges for a single day. This is roughly a third of the total charge. The nursing staff ratios on units vary depending on each unit. The first unit that this patient was in, the (CVICU), normally has a 1:2 nurse to patient ratio. He was then transferred to the step-down unit where there is normally a 1:4 nurse to patient ratio. After staying three days in the step-down unit the patient was discharged home.

Discharged to Community In most cases after CAD patients have undergone surgical intervention; they are discharged home and need no home health. After discharge, they visit their cardiovascular surgeon for a follow-up appointment and if everything is within normal limits they are released to their primary physician and should begin cardiac rehab at this time (Gail Spratlin, personal communication, October 13, 2010). Once the patient is back in the community, health maintenance is very important. There are different levels of prevention that are used to reach adequate health status. The first level is primary prevention, which involves health maintenance, health promotion, and risk factor screening. Some aspects addressed in this level include: smoking cessation, blood pressure control, lipid management, physical activity, and weight and diabetes management (American Heart Association, 2010). In the community, the Auburn Housing Authority has free weekly clinics that are open to the public. At these clinics blood pressure, blood sugar, and weight are assessed and feedback is given based on the results. In addition, other education can be provided through the nurses running the clinic or information pamphlets that are available. The next level of prevention is secondary prevention, which involves identifying and treating patients with CAD and those that are at risk for developing CAD. This level involves going to a physician and being evaluated for this heart condition (American Heart Association, 2010). There are many primary physicians available in the Lee County community and the costs vary depending on services provided and the patient’s insurance plan. Tertiary prevention is the last level in the process and it involves rehabilitation and attending support groups. Cardiac rehabilitation is in this level of prevention and patients are encouraged to attend but physician referral is required. In the Lee County community there are cardiac rehabilitation services available at EAMC. The out-of-pocket cost for these services depends on the patients’ insurance coverage. For patients attending this program, they are encouraged to go three times a week for an average of eight to twelve weeks depending on the severity of the condition. The services include a physical activity program and patient education, which will be provided by a multidisciplinary team that consists of nurses, respiratory therapists, dieticians, and exercise physiologists (Gail Spratlin, personal communication, October 13, 2010). In order for clients to reach their optimal health status, the AHA practice guidelines suggest that all post CABG patients attend a cardiac rehabilitation program (Smith et al., 2006). Proposed Intervention The proposed intervention for this project is a primary prevention program focused on diet to prevent CAD. The target population is adolescents in Lee County, specifically those in the Auburn area. This target population was chosen, because according to the Healthy People 2010, atherosclerosis (the main problem in CAD) starts in adolescence. This problem pertains to all people living in the United States, but the intervention can only be targeted to a specific population. This intervention program can also be considered a secondary prevention program, because it can speak to the parents of teenagers, who can incorporate the information presented into their own lifestyles in order to maintain, promote, and better their own health. Even if genetics provide a barrier between complete prevention and CAD, dietary interventions can modify atherosclerotic risk (Merz et al, 2009). Studies have shown that a dietary intervention can decrease risk factors for CAD. In fact, “the absence of the major established CAD risk factors at 50 years of age has been shown to indicate a 90% lower lifetime risk (to age 95 years) for men and a 79% lower risk for women” (McGill et al, 2008).

Healthy People 2010 points to four main risk factors that effect heart disease: high blood pressure, high cholesterol, obesity and cigarette smoking. Three of these four risk factors can be modified with a diet if they are not too tied into one’s genetics. Healthy People 2010 (Heart Disease and Stroke, 2010), also shows that studies have found that risk factors for heart disease “develop early in life: atherosclerosis already is present in late adolescence, diabetes in overweight children is on the rise, and hypertension can begin in the early teens.” This information points to the fact that the most important target population, in order to be the most primary preventative intervention, needs to start at the beginning: the teenage years. Diet is one of the three main components to having a healthy heart. Exercise and stress management are the other two components (Daubenmier et. al, (2007). Smoking cessation is also important to promoting heart health, but the easiest and most primary way to prevent heart disease is to put nutritious, “heart healthy” foods into your body. One way to promote heart health is to implement a diet that is low in plaque-building molecules. Then, the problems that lead to atherosclerosis and CAD are decreased.

In order to perform a health risk appraisal, the group members in this project will go to Auburn High School and work with a health educator in speaking to students. They will interact with the students and identify learning needs (see appendix) pertaining to heart healthy diet components.

There are three phases to the intervention program. Phase one includes the first interactive session, in which the health risk factor identifier will be implemented. Each student will fill out the health risk appraisal form (see appendix), and be weighed and measured in height, in order to obtain a body mass index (BMI) calculation.

Phase two will incorporate the learning needs identification form (see appendix), that each student will fill out. From the result of these forms, the group will focus the teaching session (see appendix) on the risk factors and knowledge deficits identified. The teaching session will educate students about CAD, BMI, important molecules in food, nutrition information and will provide information on how to choose heart healthy foods using The American Heart Association and MyPyramid as resources. Both the Centers for Disease Control (CDC) and the American Heart Association have a list builder with products recommended for heart health, which will also be discussed with the students.

Phase three is the evaluation stage, in which each student, and the health educator will fill out an evaluation form (see appendix) on the presentation made by this group. From these evaluations, the group can evaluate teaching methods, information presented, and identify areas for future research. Conclusion

In summary, CAD is one of the leading causes of death throughout the world. This is most likely due to the increased number of citizens with increased risk factors for adverse cardiac events. The patient used in this paper is a prime example of a person with many risk factors, which lead to the development of CAD. Because so many citizens are affected by heart disease, a community intervention program is essential to educate people of the importance of heart health. The idea of an intervention program is grounded in evidence-based practice, current health guidelines, and current research studies and has a goal to reduce risk factors of CAD. The evidence suggests that atherosclerosis begins in the early phases of life, mainly the teen years. This evidence leaves no extra thought as to how to prevent CAD. More research and thought should be given to preventing CAD early and implementing an intervention program into schools across the nation.

References

Alabama Department of Human Resources. (2010). DHR Services. Retrieved from

Alabama Department of Public Health. (2008). Lee County Health Statistics. Retrieved from

Alabama Department of Public Health. (2010). Cardiovascular Health.

American Heart Association. (2010). Cardiovascular Disease Statistics. Retrieved from

American Heart Association. (2010). Primary and secondary prevention in the adult. Retrieved from

Cassar, A., Holmes, D., Rihal, C., & Gersh, B. (2009). Chronic coronary artery disease: diagnosis and management. Mayo Clinic Proceedings, 84(12), 1130-1146. doi:10.4065/mcp.2009.0391.

Center for Disease Control and Prevention. (2001). 2001 Alabama State of the Heart Report. Retrieved from

Center for Disease Control and Prevention. (2007). Heart Disease. Retrieved from

Choudhry, N., & Winkelmayer, W. (2008). Medication adherence after myocardial infarction: a long way left to go. JGIM: Journal of General Internal Medicine, 216-218. doi:10.1007/s11606-007-0478-8.

Daubenmier, J. J., Weidner, G., Summer, M. D., Mendell, N., Merritt-Worden, T., Studley, J., & Ornish, D. (2007). The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program. Annals of Behavioral Medicine, 33(1), 57-66.

East Alabama Medical Center. (2010). Programs and Services. Retrieved from

Healthy People 2010. (2010). Heart Disease and Stroke. Retrieved from

Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., &

Rosamond, W. D. (2010, February 2). Defining and setting national goals for cardiovascular health promotion and disease reduction. The American Heart Association's strategic impact goal through 2020 and beyond. Circulation: Journal of the American Heart Association, 585-613. doi:10.1161/CIRCULATIONAHA.109.192703

McGill, H. C., Jr., McMahan, C. A., & Gidding, S. S. (2008, March). Preventing heart disease in the 21st century: Implications of the pathobiological determinants of atherosclerosis in youth (PDAY) study. Circulation: Journal of the American Heart Association, 1215-1227. doi:10.1161/ CIRCULATIONAHA.107.717033

Mertz, C. N., Alberts, M. J., Balady, G. J., Ballantyne, C. M., Berra, K., Thompson, P.

D. (2009). ACCF/AHA/ACP 2009 competence and training statement: A

curriculum on prevention of cardiovascular disease. Circulation: Journal of the American Heart Association, e98-e115. doi:10.1161/CIRCULATIONAHA.109.19264

PayScale. (2010). Hourly rate snapshot for registered nurse (RN) jobs. Retrieved from (RN)/Hourly_Rate

Smith, S., Allen, J., Blair, S., Bonow, R., Brass, L., Fonarow, G., Grundy, S., Hiratzka, L., Jones, D., Krumholz, H., Mosca, L., Pasternak, R., Pearson, T., Pfeffer, M., & Taubert, K. (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Journal of American Heart Association, 113, 2363-2372. doi:10.1161/CIRCULATIONAHA.106.174516

SurgeryPlanet. (2006). Retrieved from

Yang, Z., Shen, W., Zhang, R., Kong, Y., Zhang, J., Hu, J., Zhang, Q., & Ding, F. (2007). Coronary artery bypass surgery versus percutaneous coronary intervention with drug- eluting stent implantation in patients with multivessel coronary disease. Journal of Interventional Cardiology, 20(1), 10-16. doi:10.1111/j.1540-8183.2007.00222.x.

Healthy People 2010. (2010). Opportunities;primary prevention. Retrieved from



Centers for Disease Control and Prevention. (2010). Deaths and Mortality. Retrieved from



U.S. Census Bureau. (2000). Opelika City Demographics. Retrieved from

U.S. Census Bureau. (2009). State and County QuickFacts. Retrieved from

U.S. National Library of Medicine. (2010). Coronary Artery Disease. Retrieved from

Appendices

• Selected chart p. 24

• Health Risk Appraisal Form p.25

• Learning Needs Identification Form p.26

• Copy of actual teaching information p. 27-29

• Evaluation Form p.30

Selected Chart

[pic]

Auburn University School of Nursing

Coronary Artery Disease

Health Risk Appraisal

You do not need to put your name on this form ( Are you (circle) male female

Please circle one of the numbers following the questions:

1. How much do you consider nutrition None A little Moderate A great deal

when you choose the foods you eat? 0 1 2 3

2. Please rate your stress level: 0 1 2 3

3. How many times do you exercise per week? 0 1 2 3 or more

Please check “yes” or “no”:

4. Do you eat a low fat diet? ____yes ____no

5. Do you eat a low sodium diet? ____yes ____no

6. Do you currently have high blood pressure? ____yes ____no

7. Does anyone in your family have high blood pressure? ____yes ____no

If so, please list your family members (ex: mother, father, grandmother, uncle, sister, ect.)

8. Do you have diabetes? ____yes ____no

9. If yes to #6 (skip if answered no) is your blood sugar controlled? ____yes ____no

10. Does anyone in your family have diabetes? ____yes ____no

If so, please list your family members (ex: mother, father, grandmother, uncle, sister, ect.)

11. Do you have heart disease? ____yes ____no

If so, please specify disease:

12. Does anyone in your family have heart disease or died from heart disease? ____yes ____no

If so, please specify disease and family member:

Auburn University School of Nursing

Coronary Artery Disease

Learning Needs Identification

You do not need to put your name on this form (

1. Do you know what Coronary Artery Disease (CAD) is? ____yes ____no

2. Do you know what atherosclerosis is? ____yes ____no

3. Do you think preventing CAD is important? ____yes ____no

4. Do you think a low fat diet is important? ____yes ____no

5. Do you incorporate a low fat diet into your lifestyle? ____yes ____no

6. Do you think a low sodium diet is important? ____yes ____no

7. Do you incorporate a low sodium diet into your lifestyle? ____yes ____no

8. Have you heard of the American Heart Association? ____yes ____no

9. Have you heard of “MyPyramid”? ____yes ____no

Teaching Information

1[pic] 2 [pic]

3[pic] 4[pic]

5[pic] 6[pic]

7[pic] 8[pic]

9[pic] 10[pic]

11[pic] 12[pic]

13[pic] 14[pic]

15[pic]

Auburn University School of Nursing

Coronary Artery Disease

Evaluation Form

You do not need to put your name on this form (

Timely presentation of outline: ____yes ____no

Rate the group as a whole out of 10 in each section:

1. Intent of the presentation is clear _____________/10 pts

2. The students had apparent knowledge of the content _____________/10 pts

3. The content presented was at the appropriate knowledge level _____________/10 pts

4. The content was relevant to my life _____________/10 pts

5. The teaching material was appropriate _____________/10 pts

6. Two-way participation encouraged _____________/10 pts

7. The presentation maintained my attention _____________/10 pts

8. Content was presented completely, as planned _____________/10 pts

9. My questions were answered _____________/10 pts

10. The group catered to my/the class’s needs _____________/10 pts

Comments:

Thank You!

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