NR 576 Week 7 Assignment; Clinical Practice Guidelines Presentation; Coronary Artery Disease (CAD)

Disease Condition • The selected CPG that will be discussed is primary prevention of cardiovascular disease, according to ACC/AHA guidelines • The ACC/AHA Task Force on CPG was commissioned to aid in consolidating existing guidelines, as well as various research and newly confirmed improvement treatment/strategies by experts into a single practice guideline on the primary prevention of CAD • Coronary artery disease (CAD) is a term that refers to the build up of plaque in vessels, known as a atherosclerosis Disease Epidemiology • Although there has been substantial improvement in CAD outcomes in recent decades, it remains the leading cause of morbidity and mortality globally (Arnett, 2019) • Accounts to an estimated health care cost of >$200 billion dollars annually • CAD is common, more so in older adults. Prevalence rises from 6.9% in men and 6.6% in women ages 40 to 59 years to 33.9% in men and 21.6% in women ages 80 years and older (Virani, 2021) • In the US, the lifetime risk of developing CAD at age 40 years is one in two for men and one in three for women This Photo by Unknown Author is licensed under CC BY-ND Applicability in Primary Care • This CPG was developed by the ACC/AHA Task Force • Consists of members who are leaders in the field of cardiovascular medicine • Members are composed of a wide array of different backgrounds, representing different geographic regions, sexes, races, ethnicities, intellectual perspectives/biases, and scopes of clinical practice • The task force implements rigorous policies and methods to ensure that the documents are composed/developed without bias or improper influence • The original guidelines were published in 1980 relating to primary prevention of CAD. Over the years, many modifications to the guidelines have been made. Notable CPG guideline modifications Key Action Statements & Body of Evidence • In the primary care setting the provider should consider and address social determinants of health to better prevent CAD • Key actions: • Adults should be routinely assessed for psychosocial stressors and provided with appropriate counseling (DeFilippis, 2017) • Potential barriers to adhering to a heart-healthy diet should be assessed, including food access and economic factors • In addition to the prescription of type 2 DM interventions, environmental and psychosocial factors, including depression, stress, self-efficacy, and social support, should be assessed (Gonzalez, 2016) • For adults 40 to 75 years of age, clinicians should routinely assess traditional cardiovascular risk factors and calculate 10-year risk of CAD by using the pooled cohort equation (PCE) (AC, 2018) • Social support for adults who use tobacco, assistance and arrangement for individualized and group social support counseling are recommended (Verbiest, 2017) Application in Clinical Contd. • Patient possesses several risk factors of CAD • Smoking history • Hypertension • Hyperlipidemia • BMI >24.9 • Depression (PHQ9=12) • According to the CPG several issues were addressed during the visit: • Diet and exercise were discussed and encouraged • Advised to resume current hypertension and hyperlipidemia medications • Depression symptoms addressed.