Primary Care Cardiovascular Disease Management Assignment Sample

Enhance patient care with integrated CVRM programs and multi-professional approaches. Learn more about managing cardiovascular risk factors effectively.

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Introduction Of The Primary Care Cardiovascular Disease Management

The aim of this assessment is to review a case study related to the management of a person at risk of Cardiovascular disease within an individual primary care practice.

Cardiovascular disease or CDV is such a disorder which has contributes to morbidity and mortality within a population. Prevention and managing the risk of CVD within an individual at primary care practice is, therefore, important initiatives and need total concentration. To meet the aim of this assessment, the case scenario of “Design of the ZWOT-CASE study: an observational study on the effectiveness of an integrated programme for cardiovascular risk management compared to usual care in general practice” by Marchal et al. (2019) to be taken into consideration.

In this case study, the focus has been given to the management process of cardiovascular disease at primary care practice in the Netherlands. As per this case scenario, in the Netherlands, a person at risk with CVD is being prescribed to go through the CRM (Cardiovascular risk management process) based on CCM or Chronic Care Model.

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PTS1 Personal and Transferable Skills

A different option to provide care to the patient at risk of CVD

According to the ZWOT-CASE study, the effect of integrated care for CVRM is on two major cardiovascular risk factors. Those factors are LDL-Cholesterol or Low-density Lipoprotein cholesterol and SBP or systolic blood pressure. This case study is based on a pragmatic observational study by comparing the result of integrated care for CVRM with the usual care of a patient with a high risk of CVD and with an age range from 40 to 80 years. As per the case study, there are national and international guidelines for cardiovascular risk management in primary care practice, which provide clinical and organisational recommendations. In recent years, an integrated care program has been considered one approach to managing patients with established cardiovascular disease (Marchal et al., 2019). This integrated CVRM care program will be patient-centric and use the clinical information system, and its execution will be done by the PNs or practised nurses.

Additionally, as the integrated CVRM care program is based on CCM, therefore, it also includes active and informed patients who used to be treated and cared for by the trained and proactive nursing team. The justification for using this approach is its composition. The integrated program composes of such a practice or nursing process that can enhance the outcome of managing the risk related to the established cardiovascular disorder for the patient in primary care practice.

Additionally, stent implantation and coronary angioplasty are another procedures that help to manage the risk of established CVD for the patient. In-stent implantation, mainly BMS or bare mental or DES or drug-eluting stent, is used to ease the blood flow in the heart. Though, coronary angioplasty can not be a permanent program to manage the risk of established cardiovascular disease in primary care. Additionally, there are CABG or Coronary Artery Bypass grafting processes which can be used for the management of risk with CVD in primary care (Marchal et al., 2021). The benefit of this program is that a bypass transplant restores a coronary artery's ability to boost blood flow during physical activity by up to four times greater than resting levels. Additionally, there is growing evidence that patients with severe coronary artery disease who have bypass surgery live longer.

While it comes to developing options or strategies to reduce the risk associated with cardiovascular disease, the foremost option that comes to mind is the lifestyle strategy. According to many studies, regular habits and activities can robustly affect the risk associated with CVD. As per the research outcome submitted by the AHA in its Strategic Plan for 2020, it can be seen that only 5-10% of people across the world achieve the “ideal cardiovascular health” (Szafraniec-Burylo et al., 2016). This involves lifestyle factors like regular physical activities, proper nutrition, managing weight, and avoiding tobacco and alcohol consumption. To make the people at risk of cardiovascular disease aware of this strategy, proper communication skill has also been adopted. Communicating the “primordial” prevention process can be another option to reduce the risk of CVD. This process highlights the prevention of the risk factors at their initial stage of occurrence (Cramm et al., 2013).

Research, Knowledge and Cognitive Skills

RKCS1 Epidemiology and pathophysiology of Cardiovascular disease

According to the chosen case scenario, the dominance of chronic diseases like Cardiovascular disorder is the main contributor to the global mortality rate. In 2016-17, 30 per cent of global deaths were caused due to onset of cardiovascular disease. According to the report published by WHO, the most prominent epidemiology of the cardiovascular disease is the uncontrolled and unhealthy lifestyle. CVDs is a group of disorders related to the health and blood vessel, and it includes coronary health-related diseases, cerebrovascular diseases, and other conditions (Cramm et al., 2013). Though, as per many surveys, four out of five cardiovascular disease-related deaths are occurred due to sudden and severe health failure and heart attack or strokes. The most common epidemiology of cardiovascular diseases is a behavioural risk, which includes an unhealthy diet and physical inactivities. Additionally, excessive consumption of tobacco and alcohol are other factors in the onset of these diseases.

Individuals may experience elevated blood pressure, elevated blood glucose, elevated blood lipids, as well as overweight and obesity as a result of behavioural risk factors. These "intermediate risk variables" can be assessed in primary care settings and point to an elevated risk of consequences like heart attack, stroke, and heart failure (Schmidt et al., 2018). The epidemiological studies refer that a significant percentage of CVD mortalities cause by young populations and children in developing countries due to malnutrition, poverty, unemployment, and excessive consumption of tobacco and alcohol at an early age. Other epidemiological studies also show that acute decompensated heart disease is caused due to cardiomyopathy, hypertension and RHD in the majority of cases (Cramm and Nieboer, 2012).

The pathophysiology of cardiovascular diseases is angina pectoris, myocardial infarction or MI, dysrhythmias, and inflammatory processes. Atherosclerosis is the primary cause of cardiovascular diseases. As per the research, hypercholesterolaemia, hypertension, and smoking are the significant risk factors for atherosclerosis. The primary pathophysiology of the onset of cardiovascular diseases is the oxidation and inflammation in artery walls that, with time, may cause fatty-fibrous lesions (Goodwin, 2013). An unhealthy lifestyle, like physical inactivity, hypertension and anxiety, can cause the rupture of those lesions, which lead to a clinical emergency like health failure or stroke.

As per th case scenario, the disease progression related to cardiovascular disorders can be marked by the inflammatory indicators CRP or C-reactive protein, the early indicator of the disease or heart attack is the CD40 marker and cardiac myofilament protein, troponin. The pathophysiology of cardiovascular diseases can be defined by the uncontrolled calcium signalling to the myofilament, which indicates the onset of HF or heart failure and cardiomyopathy. Enhanced and improved calcium signalling can suppress the onset of HF (Bosselmann et al., 2020).

RKCS2 Investigation of the relationship between Risk factors and Cardiovascular disease

In the pathophysiology of cardiovascular disease, it has been mentioned that excessive hypertension and anxiety can produce cardiac hypertrophy and it can rupture the lesion at arterial walls. Hypertension is directly connected with high blood pressure. Now to link high blood pressure and cardiovascular disease, it can be stated that when the pressure of the blood flow in arteries and blood vessels is too high, it can affect the systolic and diastole of the heart and cause heart failure (Bosselmann et al., 2020). On the other hand, an unhealthy diet can increase the level of low-density lipoprotein in the kidney. This can trigger the production of fatty-fibrous lesions in the arterial wall and lead to the onset of cardiovascular diseases.

Additionally, excessive consumption of fast or oily food, fat-rich food, can cause the precipitation of fat and cause atherosclerosis. Atherosclerosis is a buildup of fatty and fibrous plaques at the inner lining of the arteries, which in turn narrow down the artery and cause high blood pressure (Arnold et al., 2020). Overweight and obese are another two risk factors for cardiovascular diseases. It is stated in many researches that, even in the absence of any other risk factors, those with extra body fat, particularly around the waist, are more likely to develop heart disease. Weight gain makes the heart work harder and causes blood pressure to rise. As weight grows, blood cholesterol and triglyceride levels rise as well, lowering the "good" cholesterol (Purcell et al., 2014). Additionally, diabetes is more prone to develop in fat or overweight individuals.

Cardiovascular diseases are directly linked with high blood pressure. And on the other hand, eating food which contains high saturated fat can increase the sodium level in the blood within, in turn, can raise the blood pressure level (Allan et al., 2015). On the other hand, tobacco consumption is considered as one of the significant risk factors for cardiovascular diseases. Tobacco use can increase the risk of heart disease and heart attack in the following way:

  • Tobacco consumption can cause permanent damage to the heart and blood vessels, which increases the risk of heart failure or the onset of atherosclerosis.
  • Nicotine can increase the blood pressure level (Ahmed et al., 2015)
  • Carbon monoxide with produced from smoking nicotine can suppress the amount of oxygen in the blood and increase the rate of carbonated blood in the body.

RKCS3 Best Practice and guidance for managing the Cardiovascular risk factors and disease

The integrated CVRM program is the best practice and guidance to manage the risk of patients with cardiovascular diseases at primary care practice. As per the case scenario, this program or approach is well-populated in the Netherlands. Therefore, per the Dutch CVRM guideline and practical manual, the intervention includes the features of the CCM or chronic care model. More specifically, it includes self-management support or to help the patient to see limited goals and help them to identify the barrier to acquiring that targeted goals; regular follow-up at healthcare practice, record the data of patients with established cardiovascular diseases in the clinical information system; developing and practising a structured and nurse-led healthcare practice (Ordonez et al., 2022). The beneficial approach of this intervention program is its purpose. The aim of an integrated CVRM program is to decrease the risk of patients with established CVDs by focusing on lifestyle treatment and medication.

According to the Dutch guideline, nurses and healthcare practitioners used to set a guideline for the patient with cardiovascular diseases to suppress its risks. As per the intervention approach, it should be necessary for the caregivers and practitioners to check whether the patient with CVDs has quit smoking and whether the BMI rate is <25 kg/m2 to 30 kg/m2 (Siontis et al., 2021). As per the intervention, the nurses should also monitor the systolic blood pressure level of the patient along with the LDL cholesterol level at regular intervals. This intervention also includes an awareness campaign, where people with a high risk of CVDs are aware of the importance of following a balanced diet and healthy lifestyle (Mosenzon et al., 2021).

The organisational strategies for an integrated CVRM program are:

  • Systematic identification of the patient eligible for CVRM
  • Regular follow-up of the patients
  • Collaboration with separate disciplinaries at a healthcare setup
  • Record data in an information system for managing the risk of CVDs and improve the outcome of the integrated care

In this integrated care practice, the patient with a high risk of established cardiovascular disorders is actively invited to take consultation. After thorough checkups, the practitioners keep patients in a continuous monitoring process on a regular basis (Marchal et al., 2019). The frequency of follow-up of the patient with a risk of established CVDs varies from one patient to another based on the severity of the disease and treatment goals. Well-trained PNs who identify patients, study medical data, interview patients, and conduct examinations are employed by general practises carrying out the integrated care intervention. All of the PNs had fundamental training, which included instruction in CVRM.

Additionally, although it is not required, some of the PNs took a specialisation course in CVRM. The GP is in charge of the PNs. If necessary, a dietitian or physical therapist may be consulted. Additionally, if necessary, a hospital specialist can be immediately consulted online (Szafraniec-Burylo et al., 2016). Therefore, an integrated CVRM strategy can be considered as one of the best and preferable ways and guidelines to suppress the risk of a patient with established cardiovascular diseases in the primary care unit.

Professional Skills

PS1 risk of Cardiovascular disease

Risk assessment is one of the professional skills with which the risk of the cardiovascular disorder can be identified. Risk assessment can be done by using the health risk assessment or health risk appraisal. It is an instrument used to collect health-related data and information, coupled with the process which includes biometric testing. With this professional skill, healthcare professionals or practitioners can assess or measure the health status of the individuals, risk and their habits. For example, the risk assessment technique for cardiovascular disorders includes age, habit, and behavioural approaches (Schmidt et al., 2018).

Risk factors for cardiovascular diseases Sex-specific (separate models for men and women)
  • Age (in years 30 to 60 years)
  • Blood pressure (JNC-V) Total cholesterol (NCEP) HDL cholesterol (NCEP) Diabetes Smoking

PS2 care Strategies to promote the health and well-being of patients with cardiovascular disease

Integrated CVRM program for individual patients:

  • Regular consultation
  • Regular follow-up visits
  • Option to referral to get support in changing livelihoods

Another strategy to promote the health and well-being of patients with cardiovascular diseases is to carry out an awareness program. In a people-centric awareness program, the healthcare professionals will make the people vulnerable to heart disease regarding the followings:

  • Get moving- make the people set a goal regarding targeted heart rate. Make the people involved in regular activities (Goodwin, 2013). Motivate people to stick with for the long run
  • Quit smoking- strategy to quit smoking is:
  • Make a schedule
  • Keep yourself busy
  • Sign up to stop smoking -classes
  • Stay positive and bring changes in the regular habit
  • Motivate people to eat heart-healthy foods- as healthcare professionals, a diet chart can be set up for people vulnerable to the onset of cardiovascular disorder. Additionally, make the people motivated to check their BMR and body weight through regular observation (Cramm and Nieboer, 2012). Prescribe the patients to take an active part in physical activities to maintain body weight, cholesterol and fatty acid level in check.

PS3 Modification of care delivery process in response to the assessment practice with the risk of cardiovascular disease

An integrated CVRM program is one of the best ways to promote the health and well-being of people with a risk of cardiovascular disorders. This program includes consultation, regular follow-up and referral to change lifestyle as the main features of the intervention process. Additionally, in this strategy, a risk assessment tool has been set up based on some selective attributes, like age, sex, BMI rate, and body weight (Arnold et al., 2020). To enhance or modify the care delivery process, the focus has to be given to making the intervention strategy more patient-centric. Along with the regular follow-up. In this intervention process, motivational courses and strategies to improve the mental health and well-being of the patient have to be implemented. With motivational courses and counselling, professionals can make the patient influence or lead to the way of living a healthy lifestyle (Bosselmann et al., 2020). Additionally, in the risk assessment program, professionals can also include the follow-up of other health statuses of the patients vulnerable to the onset of cardiovascular diseases.

PS4 Importance of multi-professional approach to care

The CVRM programme places a lot of emphasis on collaboration with other disciplines in the healthcare system, including general practitioners, medical specialists, practise nurses and -assistants, dieticians, and physiotherapists. Well-trained PNs who identify patients, study medical data, interview patients, and conduct examinations are employed by general practises carrying out the integrated care intervention. All the PNs followed basic training, including basic education in CVRM. Additionally, although it is not required, some of the PNs took a specialisation course in CVRM. The GP is in charge of the PNs. If necessary, a dietitian or physical therapist may be consulted. Additionally, if necessary, a hospital specialist can be immediately consulted online. A multidisciplinary information system's patient data is accessible to other disciplines if they are participating.

Conclusion

In order to conclude this assessment, it can be stated that the importance of developing a strategy to suppress risk with established cardiovascular disorders among patients in primary care can never be denied. In this assessment, the focus has been given to a selected case scenario, where integrated CVRM has been included as the primary approach or strategy to prevent the risk of a patient with CVDs in primary care.

References

Ahmed, M.H., Husain, N.E.O. and Almobarak, A.O., 2015. Nonalcoholic Fatty liver disease and risk of diabetes and cardiovascular disease: what is essential for primary care physicians?. Journal of family medicine and primary care, 4(1), p.45.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367006/

Allan, G.M., Lindblad, A.J., Comeau, A., Coppola, J., Hudson, B., Mannarino, M., McManis, C., Padwal, R., Schelstraete, C., Zarnke, K. and Garrison, S., 2015. Simplified lipid guidelines: Prevention and management of cardiovascular disease in primary care. Canadian Family Physician, 61(10), pp.857-867.https://www.cfp.ca/content/61/10/857.short

Arnold, C., Hennrich, P., Koetsenruijter, J., van Lieshout, J., Peters-Klimm, F. and Wensing, M., 2020. Cooperation networks of ambulatory health care providers: exploration of mechanisms that influence coordination and uptake of recommended cardiovascular care (ExKoCare): a mixed-methods study protocol. BMC family practice, 21(1), pp.1-9.https://link.springer.com/article/10.1186/s12875-020-01229-3

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Cramm, J.M. and Nieboer, A.P., 2012. The chronic care model: congruency and predictors among patients with cardiovascular diseases and chronic obstructive pulmonary disease in the Netherlands. BMC Health Services Research, 12(1), pp.1-6. https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-12-242

Cramm, J.M., Tsiachristas, A., Walters, B.H., Adams, S.A., Bal, R., Huijsman, R., Rutten-Van Mölken, M.P. and Nieboer, A.P., 2013. The management of cardiovascular disease in the Netherlands: analysis of different programmes. International Journal of Integrated Care, 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807633/

Goodwin, N., 2013. How do you build programmes of integrated care? The need to broaden our conceptual and empirical understanding. International journal of integrated care, 13https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812348/.

Marchal, S., Hollander, M., Schoenmakers, M., Schouwink, M., Timmer, J.R., Bilo, H.J., Schwantje, O., van’t Hof, A.W. and Hoes, A.W., 2019. Design of the ZWOT-CASE study: an observational study on the effectiveness of an integrated programme for cardiovascular risk management compared to usual care in general practice. BMC Family Practice, 20(1), pp.1-12.https://link.springer.com/article/10.1186/s12875-019-1039-z

Marchal, S., van't Hof, A.W., Bilo, H.J., Deijns, S.J., Heeg, J.E., Schoenmakers, M., Schouwink, M., Schwantje, O., Bots, M.L., Hoes, A.W. and Hollander, M., 2021. Integrated cardiovascular risk management programme versus usual care in patients at high cardiovascular risk: an observational study in general practice. BJGP open, 5(2).https://bjgpopen.org/content/5/2/BJGPO.2020.0099?utm_source=trendmd&utm_medium=cpc&utm_campaign=BJGP_Open

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Purcell, R., McInnes, S. and Halcomb, E.J., 2014. Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews. BMC family practice, 15(1), pp.1-14.https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-15-43

Schmidt, C., Oener, A., Mann, M., Krockenberger, K., Abbondanzieri, M., Brandewiede, B., Bruege, A., Hostenkamp, G., Kaiser, A., Neumeyer, H. and Ziegler, A., 2018. A novel integrated care concept (NICC) versus standard care in the treatment of chronic cardiovascular diseases: protocol for the randomised controlled trial CardioCare MV. Trials, 19(1), pp.1-10.https://link.springer.com/article/10.1186/s13063-018-2502-1

Scientist, K.C., Noseworthy, P.A., Attia, Z.I. and Friedman, P.A., 2021. Artificial intelligence-enhanced electrocardiography in cardiovascular disease management. Nature Reviews Cardiology, 18(7), pp.465-478.https://www.nature.com/articles/s41569-020-00503-2

Szafraniec-Burylo, S., Sliwczynski, A., Tyszko, P., Prusaczyk, A., Zuk, P., Foryszewska-Witan, E., Prusaczyk, A., Guzek, M., Wlodarczyk, T. and Orlewska, E., 2016. The implementation of integrated care for cardiovascular diseases in Poland. International Journal of Integrated Care, 16(6).https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-021-01602-w

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