Reducing the Risk of Cardiovascular Disease Within the U.S. Population

Introduction

Population health, which is a common concept in the healthcare context, refers to a framework that aims at realigning the healthcare delivery system. Irrefutably, the global healthcare delivery system is known to be fragmented, poorly managed, ineffective, wasteful, and economically unviable and inequitable. Population health refers to a cohesive, comprehensive, and integrated approach to healthcare that takes into account how health outcomes are distributed within a given population, the health determinants influencing the dissemination of care, as well as the policies and interventions that influence and are impacted by the determinants (Nash, 2016). Primarily, population health calls for the coordination of a wide range of care interventions that include health promotion, prevention, screening, behavioral change, chronic care and disease management, and provision of consumer education with an emphasis on self-management. This essay focuses on a component of the population health paradigm known as health promotion. According to the World Health Organization (WHO), health promotion is a process that allows people to increase control over their health and its determinants thereby improve their health in the long-run. Health promotion can be achieved through preventative interventions (Nash, 2016). This paper also delves into how the risk of cardiovascular disease (CVD) within the U.S. population can be reduced with a focus on prevention interventions, such as lifestyle change and modification.

Overview of Selected Population

Over the years, the emphasis has been placed on the aspect of population health worldwide. Various countries have come up with initiatives or interventions aimed at realizing the global population health objective. The United States, for instance, allocates billions of dollars annually toward the mentioned initiative given the significant percentage of the populations that are suffering and dying from preventable illnesses yearly. The focus on health population coupled with medical advances continues to have positive impacts on the health of the U.S. population. Consequently,  there has been a significant increase in life expectancy in the nation over the years (Greenlund, Keenan, Clayton, Pandey, & Hong, 2012). Reports indicate that as a result of population health, the life expectancy of the American people increased from around 74 years in 1980 to 78 years in 2006. Greenlund, Keenan, Clayton, Pandey, & Hong (2012) add that in 2006, people aged 65 and above expected to live 17 to 20 additional years on average, which is an increase of around one year since 2000. The US population is aged 65 and above was expected to grow from around 12 percent in 2007 to about 20 percent by 2050, which was projected to happen hand in hand with the doubling of the population of people aged 75 and above. All these are attributed to the efforts put in place to prevent and control illnesses and conditions such as CVD within the U.S. population.

Disease-Specific Data

Despite population health efforts that have been put the place in the U.S., CVD remains the leading cause of death in the country. Besides, it is the main source of disability and poor health-related quality of life that costs around $273 billion annually in direct medical costs. A significant percentage of the people that die from CVD are aged 65 and above. It should also be noted that despite the increase in life expectancy as mentioned, an augmented number of older adults living with CVD is often accompanied by mental and comorbid physical conditions as well as social challenges (Greenlund, Keenan, Clayton, Pandey, & Hong, 2012). Cardiovascular disease trends in the U.S. tell two stories. On the one hand, encouraging trends that show a decline in CVD mortality from 517 in every 100,000 in 1981 to 244 in every 100,000 in 2008 have been reported. On the other hand, it is evident that CVD remains to be one of the leading causes of deaths and increased healthcare costs in the U.S. (Pandya, Gaziano, Weinstein, & Cutler, 2013). It is estimated that around 610,000 people die of CVD annually in the U.S. (Centers for Disease Control and Prevention, 2017). Furthermore, CVD is one of the leading causes of death among both men and women with more than 50 percent of the deaths caused by CVD in 2009 occurring among men. A common cardiovascular condition that causes a lot of deaths in the U.S. is coronary heart disease (CHD), which kills over 370,000 people every year. The CDC estimates that around 735,000 Americans suffer from heart attacks annually with 525,000 of them being first heart attacks. 210,000 cases happen among people who have had a heart attack before.

Setting

As mentioned, cardiovascular disease is one of the leading causes of death not only in the U.S. but the world at large. Cardiovascular disease refers to the diseases of the heart and circulation. Examples include coronary heart disease, stroke, mini-stroke, and peripheral arterial disease. Stroke, which is relatively common, is whereby normal blood supply to specific parts of the brain is cut off resulting in the damage of the affected brain area.  A mini-stroke, known as a transient ischaemic attack (TIA), is not as common as stroke. CVD is majorly caused by lifestyle-related factors that can be modified as well as other factors that are changeable. Some of the adjustable risk factors for CVD include consumption of high levels of cholesterol, alcohol, and food with high sugar content; smoking; being overweight, obese, or inactive; and high-stress levels (Koene, Prizment, Blaes, & Konety, 2016). Non-modifiable risk dynamics for CVD include age given that CVD risk increases as one gets older as well as family history whereby risk augments if close blood relatives have experienced early heart disease.

Suggested Intervention

The focus should be on preventive interventions to reduce the risk of cardiovascular disease within the U.S. population. A preventive intervention that would prove pivotal in the achievement of the objective is lifestyle modification (Maruthur, Wang, & Appel, 2009). Lifestyle adjustment remains a critical component of population-based prevention strategies aimed at preventing CVD (Maruthur, Wang, & Appel, 2009). The only challenge that faces the mentioned intervention is logistical considerations since it has insufficient power to detect intervention effects of clinical outcomes. However, lifestyle modification is integral given that lifestyle patterns account for a significant percentage of CVD cases. For this intervention, the attention must be on aspects such as physical inactivity, smoking, obesity, and diet-related aspects. Cigarette smoking is known to increase the chances of suffering from CVD and is responsible for several cases of cardiovascular complications. Even after several years of smoking, quitting or stopping the habit could help to reduce the CVD risk. A person who stops smoking after five years could reduce his or her predisposition to CVD to about half that of a smoker who does not top the habit. Being overweight or obese is also known to increase susceptibility to CVD since overweight people tend to have diabetes, high blood pressure, and high blood fats. Thus, a change in lifestyle whereby one resorts to weight loss programs can help reduce CVD risk. Part of lifestyle change or modification to reduce the risk of CVD is engaging in regular physical activities. Health experts recommend at least 2.5 hours of moderate activity or 75 minutes of vigorous exercise every week for adults. Regarding excessive alcohol consumption, lifestyle modification would entail drinking not more than 3-4 units per day for men and not more than 2-3 units daily for men. When it comes to stress, research shows that having a certain amount of stress is desirable as it keeps people motivated and alert. Unfortunately, a buildup of stress sets the stage for cardiovascular complications that can be harmful to one’s health in the long run. Thus, to reduce stress levels, which would help to reduce the risk of CVD, people must find time for relaxation by taking part in simple breathing exercises, sports, music, reading, taking a walk, and meditation among others.

Literature Review

Several works of literature explore the impacts of cardiovascular disease and how reducing risk factors thereof could reduce them. According to the American Diabetes Association (2016), cardiovascular disease is one of the leading causes of deaths worldwide. As such, there is a need to assess the risk factors for CVD at least annually systematically. Some of the danger factors that people must focus on are dyslipidemia, smoking, hypertension, the presence of albuminuria, as well as a family history of the premature coronary disease. American Diabetes Association (2012) argues that one of the interventions critical to the reduction of the risk of CVD is lifestyle modification. It argues that lifestyle modification has almost similar effects to those of pharmacological monotherapy when it comes to reducing the risk of CVD. Some of the lifestyle modification strategies suggested by the American Diabetes Association include reducing excess body weight and consuming fruits and vegetables in the place of foods with high fat and sugar contents. Others are avoiding excessive consumption of alcohol whereby men should not take more than two servings per day and women no more than 1, restricting sodium intake by taking less than 2,3000mg daily, and increasing activity levels.

Stewart, Manmathan, & Wilkinson (2017) argue that cardiovascular disease is a significant and ever-growing problem, particularly in countries such as the U.S. and UK. They pinpoint that the disease accounts for nearly one-third of all deaths in the UK and leads to significant morbidity in the country. The article also states that developing countries continue to experience a change in lifestyle, which has introduced novel risk factors for cardiovascular disease, a perspective that ought to be of particular and pressing interest for stakeholders in the global healthcare system. One of the ways of ameliorating the burden of cardiovascular disease is reducing risk thus the primary interventions must be prioritized by developers of health policy. According to international guidelines, some of the primary prevention interventions that could ameliorate the problem in question are smoking cessation, weight optimization, and regular engagement in exercise. Other areas of future interest when it comes to reducing susceptibility to cardiovascular disease include serum urate reduction and reduction of homocysteine levels.

Cultural Considerations

In the reduction, the potential of acquiring the cardiovascular disease, stakeholders such as clinicians, nurses, researchers, and policymakers must consider cultural diversity in the contemporary society. According to Hughes (2017), the occurrence of disease, particularly in the United States, varies from one cultural group to another with nonwhite populations suffering a disproportionate amount of illnesses, injury, disability, and premature death. The cultural groups-based disparities in the occurrence of disease occur across the conditions with cardiovascular disease being among them, which underscores the need to consider cultural diversity in contemporary society when reducing the risks of CVD. Some of the cultural factors that must be considered are dietary patterns, exercise habits, and health behaviors (Hughes, 2017). Exercise habits, for instance, vary considerably from one individual to another and among cultures throughout nations. Research indicates that in the U.S., ethnic minority and low-income populations have the lowest rates of leisure-time physical activities, which underscores the highest rate of cardiovascular disease within the group. It is believed that people are often shaped by cultural forces that in turn affect various communication behaviors. Health behaviors, such as regular involvement in screening exams and imaging, physician consultations, and blood tests, are a form of communication although they too vary from one culture to another (Hughes, 2017). Considering the mentioned cultural aspects could play a key role in determining the success or failure of the health promotion project aimed at reducing the risks of cardiovascular disease within the U.S. population.

QSEN Implications

QSEN competencies help to meet the challenge of preparing future nurses in their role of improving the quality and safety of healthcare. These proficiencies include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (“QSEN Competencies,” n.d.). Of these, teamwork and collaboration are crucial to the development and implementation of the suggested health promotional plan or project, which is lifestyle modification. The teamwork and collaboration know-how entails effective functioning within nursing and inter-professional teams whereby it fosters open communication, mutual respect, and shared decision-making with a focus on achieving quality patient care (“QSEN Competencies,” n.d.). Thus, in the implementation of the suggested health promotion plan (lifestyle modification) within the general U.S. population, it is expected that nursing professionals could play a role by showcasing skills, such as acting with integrity, consistency, and respect for differing views. They could also prove vital by showcasing knowledge, such as the analysis of the difference in communication style preferences within the population as well as among nurses and other members of teams involved in the implementation of the project.

Budgetary Needs

Lifestyle modification would entail the implementation of programs at the community level to enhance the population’s awareness of the need for and how to change their lifestyle patterns. For the successful application of the project, numerous resources would be required. Some of the assets that would be needed are human, technological, and financial. Thus, funds will be allocated to transportation as the project would be carried out in different states in the U.S., campaigns on various platforms, and remuneration of those involved in the execution of the project. Funding would also be provided for the development of clinical guideline that would offer support for the delivery of best-practice care to persons at risk or with cardiovascular disease. Indeed, the implementation of the project or plan would be accomplished in collaboration with renowned organizations, such as the National Stroke Association and the American Heart Association. This implies that funding would also be availed to these institutions.

Possible Funding Sources

Organizations such as the National Stroke Association and the American Heart Association, which will work for hand in hand with several stakeholders, will be funded to facilitate the implementation of the project. The money will come from the federal, state, and local governments, all of which are committed to ensuring population health. Other reserves will be obtained from international health organizations, such as the World Health Organization, which is committed to reducing morbidity and mortality rates that result from illnesses such as the cardiovascular disease.

Timeline for Implementation

The project will be implemented in collaboration with various healthcare organizations across the United States. As such, it is expected that its completion may take around three months. The project will run for three months; from the beginning of Augusts to the end of November 2018.

Evaluation Methods

Audit performance and obtaining feedback from the general public are some of the methods that will be used to evaluate the success or failure of the project. The two approaches will utilize electronic means such as email, which will provide people with questionnaires about whether or not lifestyle modification has helped to reduce the risk of cardiovascular disease. It is expected that audit performance, and feedback will be significant if a large percentage of the population that stands to benefit from the project will be emailed.

Conclusion and The Influence of My Christian Worldview on Population Health

Population health calls for the coordination of care interventions that include health promotion, prevention, screening, behavioral change, chronic care management, disease management, and provision of consumer education with an emphasis on self-management. Population health has driven the world to make major healthcare progress over the years. The perspective of health promotion is also influenced by religious perspectives, specifically the Christian view. The New Testament tells of Jesus Christ of Nazareth’s commitment to healing the sick, and in this way ensuring population health. Luke 9: 2 (The New King James Version) says that “He sent them (the twelve disciples) out to preach the kingdom of God and to heal the sick.” The New Testament in Matthew 25: 36 further mentions Jesus’s statement to his disciples that by looking and taking care of the sick, they were looking after him (Jesus). This Christian worldview of health promotion sees more people get committed to achieving the global population health objective.

 

 

References

American Diabetes Association. (2016). 8. Cardiovascular disease and risk management. Diabetes Care39(Supplement 1), S60-S71. Retrieved from http://care.diabetesjournals.org/content/diacare/39/Supplement_1/S60.full.pdf

Centers for Disease Control and Prevention. (2017, November 28). Heart Disease Facts. Retrieved from https://www.cdc.gov/heartdisease/facts.htm

Greenlund, K. J., Keenan, N. L., Clayton, P. F., Pandey, D. K., & Hong, Y. (2012). Public health options for improving cardiovascular health among older Americans. American journal of public health102(8), 1498-1507. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464825/

Hughes, M. (2017, August 14). Cultural Factors for Heart Disease. Retrieved from https://www.livestrong.com/article/155187-cultural-factors-for-heart-disease/

Koene, R. J., Prizment, A. E., Blaes, A., & Konety, S. H. (2016). Shared risk factors in cardiovascular disease and cancer. Circulation133(11), 1104-1114. Retrieved from http://circ.ahajournals.org/content/circulationaha/133/11/1104.full.pdf

Maruthur, N. M., Wang, N. Y., & Appel, L. J. (2009). Lifestyle interventions reduce coronary heart disease risk: results from the PREMIER Trial. Circulation119(15), 2026-2031. Retrieved from http://circ.ahajournals.org/content/circulationaha/119/15/2026.full.pdf

Nash, D. B. (2016). Population health: Creating a culture of wellness. Burlington, MA: Jones & Bartlett Learning. Retrieved from http://app.compendium.com/uploads/user/863cc3c6-3316-459a-a747-3323bd3b6428/4c5909e8-1708-4751-873e-4129cb2ed878/File/e558ac0d861a90a5c55cffcc2cfce988/1416502202270.pdf

Pandya, A., Gaziano, T. A., Weinstein, M. C., & Cutler, D. (2013). More Americans living longer with cardiovascular disease will increase costs while lowering quality of life. Health Affairs32(10), 1706-1714. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894660/

QSEN Competencies. (n.d.). Retrieved from http://qsen.org/competencies/pre-licensure-ksas/

Stewart, J., Manmathan, G., & Wilkinson, P. (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM cardiovascular disease6, 2048004016687211. Retrieved from http://journals.sagepub.com/doi/pdf/10.1177/20480040166872