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Movement Is Life-Optimizing Patient Access to Total Joint Arthroplasty: Cardiovascular Health Disparities

Daniel H Wiznia1, Erick M Santos, Randall C Morgan

  • 1From the Department of Orthopaedics, Yale University School of Medicine, New Haven CT (Wiznia), Corpus Christi Medical Center, Corpus Christi, TX (Santos), and W. Montague Cobb/NMA Health Institute, Washington, DC (Morgan).

The Journal of the American Academy of Orthopaedic Surgeons
|March 17, 2022
PubMed

Insights

Optimizing cardiovascular health before surgery is crucial, especially for underserved populations facing high rates of hypertension and coronary artery disease. Comprehensive preoperative assessments and interventions, including dietary changes and nurse navigator support, can improve patient outcomes.

Area of Science:

  • Cardiology
  • Public Health
  • Health Services Research

Background:

  • Cardiovascular disease (CVD) encompasses conditions like coronary artery disease (CAD) and hypertension (HTN), affecting a significant portion of American adults.
  • Management of these conditions is suboptimal (<25%), with HTN disproportionately affecting African Americans, linked to socioeconomic and educational disparities.
  • CVD is associated with increased risks of postoperative complications, including cardiovascular and cerebrovascular events, pulmonary issues, coagulopathy, and mortality.

Purpose of the Study:

  • To highlight the critical need for preoperative cardiovascular optimization in underserved communities.
  • To outline key components of a comprehensive preoperative assessment and intervention strategy for patients with cardiovascular disease.
  • To emphasize the role of nurse navigators in guiding patients through preoperative cardiovascular care pathways.

Main Methods:

  • Reviewing existing literature on cardiovascular disease prevalence, management, and preoperative risk factors.
  • Identifying essential elements for preoperative patient assessment, including social determinants of health like food security.
  • Proposing a multidisciplinary approach involving dietary modifications, exercise, pharmacologic treatment, and specialty care.

Main Results:

  • Preoperative assessment should include evaluating food security, implementing dietary changes, and promoting exercise.
  • Pharmacologic interventions and access to specialty care are vital for improving cardiovascular health.
  • Nurse navigators can effectively guide patients through complex preoperative optimization processes.

Conclusions:

  • Targeted preoperative optimization is essential for improving surgical outcomes in patients with cardiovascular disease, particularly in underserved populations.
  • Addressing social determinants of health and providing comprehensive care coordination are key to successful cardiovascular risk reduction.
  • Integrating nurse navigators into preoperative pathways enhances patient management and adherence to treatment plans.

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