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Identification of patients at risk of ischemic events for long-term secondary prevention
1Department of Nursing Education, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA. npaaxb@gwumc.edu
Insights
Secondary ischemic events are preventable with lifestyle changes and pharmacotherapies for patients with atherothrombotic vascular disease. Nurse practitioners play a key role in ensuring effective secondary prevention strategies are implemented.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Vascular Disease Management
Background:
- Atherothrombotic vascular disease poses a significant risk for recurrent ischemic events.
- Effective secondary prevention is crucial for managing patients with established atherosclerotic disease.
Purpose of the Study:
- To review the identification of patients at risk for secondary ischemic events.
- To discuss available medical therapies for secondary prevention.
- To define the role of nurse practitioners in managing these patients.
Main Methods:
- Review of ACC/AHA guidelines (2005-2007) for unstable angina, myocardial infarction, peripheral arterial disease, and ischemic stroke.
- Inclusion of AHA/ACC 2006 guidelines update for coronary and atherosclerotic vascular disease.
- Literature search using PubMed for relevant clinical articles.
Main Results:
- Preventive therapy, including lifestyle modifications and pharmacotherapies (for dyslipidemia, diabetes, hypertension, platelet function), is critical.
- Evidence indicates that secondary prevention strategies are not always effectively utilized.
- Implementation of clinical practice guidelines can reduce recurrent atherothrombotic events.
Conclusions:
- Nurse practitioners are well-positioned in primary and long-term care to assess and improve preventive care for patients with atherothrombotic vascular disease.
- Increased awareness and adherence to clinical guidelines can significantly lower the risk of recurrent events.
Purpose:
To review the identification of patients at risk of secondary ischemic events, discuss the therapies available for their medical management, and identify the role of the nurse practitioner (NP) in their primary and long-term care.
Data Sources:
ACC/AHA 2007 guidelines for the management of patients with unstable angina and non-ST-elevation myocardial infarction, ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease, AHA/ASA 2006 guidelines for patients with ischemic stroke, AHA/ACC 2006 guidelines update for patients with coronary and other atherosclerotic vascular disease, and selected clinical articles identified through PubMed.
Conclusions:
Preventive therapy in patients with atherothrombotic vascular disease is critical for reducing the risk of recurrent events. Almost all patients with atherosclerotic disease will benefit from general lifestyle modifications, and most will also benefit from appropriate pharmacotherapies targeting dyslipidemia, diabetes, hypertension, and platelet function. However, evidence suggests that secondary prevention strategies may not be utilized effectively.
Implications For Practice:
Increased awareness and implementation of clinical practice guidelines can reduce the risk of recurrent atherothrombotic events. NPs in primary care settings or in long-term care facilities are well placed to determine whether patients are receiving appropriate preventive care and to implement improvements in their management.
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