Nurses unite to improve Cardiovascular Practice

Geneva, situated at the heart of Europe, provides a fitting setting for the 10th Annual Spring Meeting of the European Society of Cardiology Council (ESC) on Cardiovascular Nursing and Allied Professionals (CCNAP), 12 – 13 March 2010, with its special theme: “Uniting to Improve Cardiovascular Practice”.

“Problems in cardiology are universal, but different countries have developed different ways of managing them. The idea of the Spring meeting is to unite nurses and allied professionals across the globe, enabling them to share best practice with the ultimate hope of raising standards of practice in cardiology,” said Professor Christi Deaton, Chairperson of the ESC Council on Cardiovascular Nursing and Allied Professions.

In the true spirit of Geneva, she added, there is a real international flavour to this year’s meeting, with the congress offering simultaneous translation from English (the official language of the ESC) to French, German and Italian. “We’re hoping this facility will help us reach out to more delegates than ever before, particularly those who may not feel completely comfortable attending meetings entirely in English.”

Marcia Leventhal, a member of the Swiss Organising Committee of the Conference, added: “Once nurses have dipped their toe into the CCNAP meeting we’re confident they’ll enjoy the atmosphere of the congress and be truly hooked and choose to return next year.”

The Spring Meeting brings together a real mix of nurses and allied professionals from a range of backgrounds, including those who work directly with patients and those who work at the sharp end of research. “The value is that it allows delegates to network and make connections. Health professionals working in direct patient care generate the questions that need to be answered by academics; while the academics have the opportunity to get research findings out to the wider community,” said Leventhal, adding  the best tip she can offer any one attending is to bring plenty of business cards. “There’ll be opportunities to make contact with nurses and allied professionals, from all over the world, who share your interests and will be pleased to exchange ideas and experiences.”

Innovations introduced for the first time this year include increasing the number of simultaneous sessions from two to three, providing the opportunity to cover even more wide ranging areas of interest. Highlights of the meeting include sessions on congenital heart disease, women and heart disease, managing heart failure in the community, advancing nursing in the cath lab, sleep disorders, health technology, psychosocial issues, rehabilitation and emergency care pre-hospitalization. “The hope is that delegates will both attend sessions in their own area of expertise, as well as sessions outside of their areas to expand their understanding and knowledge of the complexity of caring for patients with cardiovascular diseases,” said Leventhal.

Another brand new feature is an update session reviewing highlights from both the last ESC Annual Meeting and the most influential papers published over the last year in the European Journal of Cardiovascular Nursing. “The idea of these sessions is to provide an arena where we can properly explore the implications of new developments in cardiology for nursing practice,” explained Deaton.

The clinical “How to sessions” will focus on airway management skills, including how to protect the airways of unconscious patients and techniques on how to intubate patients. A second “How to session” will provide a guide to delegates on getting their work in print and delivering effective presentations. “Traditionally nurses haven’t been so good at putting themselves forward. The session aims to teach delegates the skills needed to present their work in the best possible light,” said Deaton.

Delegates will be able to put these skills to good practice in the three moderated poster sessions. “These give delegates an opportunity to present their work in front of a small audience of interested people.   A real buzz can be created around posters, providing great opportunities to get people to interact,” said Deaton.

On Friday a Satellite Symposium, scheduled to be held between 12.30 and 13.30, will feature a secondary prevention program targeting multiple cardiovascular risk factors for patients who have suffered acute coronary syndromes (ACS). To improve outcomes the  ELIPS Programme, developed by the Hopitaux Universitaires De Geneve, aims to increase long term adherence to  medications.


Sleep Disorders and heart problems

Cardiology nurses have an important role to play in spreading the  public health message that people need to get sufficient sleep to prevent both diabetes and cardiovascular complications. “Having too little sleep should be added to the more familiar cardiovascular hazards, such as being overweight, having high cholesterol and hypertension,” Professor Nancy S Redeker, from the Yale School of Nursing, will argue in the “Sweet dreams? Sleep and heart disease session” on Saturday. “It should be tackled as part of both primary and secondary prevention,” she said.

Studies suggest that people today sleep on average only 6.8 hours per night, which is 1.5 hours less than they did a century ago, and furthermore nearly one third of adults sleep less than six hours per night.

Population based studies have suggested strong associations between sleep apnoea (a condition causing temporary stoppage of breathing during sleep) and problems with glucose metabolism, with research suggesting that sleep apnoea can lead to diabetes. Metabolic problems identified in sleep deprived patients include decreases in insulin sensitivity, elevated glucose levels and elevated Haemoglobin A1C (haemoglobin bound to glucose, considered a marker of diabetes control). But studies also suggest that aside from people who have sleep apnoea,  short sleep durations (less than seven hours a day), can also predict poor metabolic control.

Several pathways, said Redeker, have been identified through which chronic  sleep deprivation might contribute to diabetes, including stimulation of the sympathetic nervous system, stimulation of the immune system, inflammation, increases in ghrelin (the hormone that increases appetite) and reductions in leptin (the hormone signalling satiety) and elevated cortisol levels on waking.

Other studies suggest sleep deprivation has direct adverse effects on both the heart and blood pressure. One study of 495 men and women aged 35 to 47, by Diane  Lauderdale and colleagues,  from the University of Chicago, showed  people who slept on average one hour less each night increased the calcium in their coronary arteries (a marker of atherosclerosis)by 16% (JAMA 2008: 300; 2859-66). An additional study from the same group showed that short sleep duration predicted significantly higher blood pressure (Archives Intern Med. 2009;169 :1055-1061).

“We’re only just beginning to recognise the hormonal and metabolic implications of sleep curtailment,” said Redeker, who believes the area represents an important new area for scientific research.

ICDs and driving

Cardiology nurses have a key role to play in communicating to patients about the importance of not driving vehicles after being fitted with implantable cardioverter defibrillators (ICDs), Tone Norekval will tell the “Health Technology and Patient Safety” session on Friday.

Patients with ICDs for primary prevention (treatment of patients at risk for life threatening arrhythmias who have never had sustained ventricular arrhythmias) and secondary prevention (treatment of patients who have survived life-threatening arrhythmias) are recognised to be at risk of sudden incapacitation that may result in death or injury to the patient, other passengers or members of the public if they get behind the wheel of a car. A consensus statement, from  the European Heart Rhythm Association (EHRA), states that  patients should not drive a vehicle  for three months after being fitted with an ICD for secondary prevention, four weeks following an ICD for primary prevention and furthermore should be permanently excluded from professional driving. Individual countries have introduced different regulations.

With driving considered by many people to be a basic necessity of modern life, it’s hardly surprising that patients report imposed driving bans as the hardest aspect of ICD implantation. One study suggests that as many as 70 % of patients who have been fitted with ICDs continue to drive, with further statistics suggesting that up to half of all patients drive daily.

Norekval, from Haukleland University Hospital (Bergen, Norway) will make the case that adequate discharge education and follow-up of patients and their family is pivotal to achieve adherence to driving bans, and that nurses are among the best placed health professionals to undertake this.

“Nurses have a really important role to play in underlining the possible serious consequences to patients of driving after having  ICDs implanted,” said Norekval, adding that the period when patients are still in hospital following implantation offers the best opportunity for counselling them. “Nurses shouldn’t give blanket advice. They need to consider each patient’s individual situation, and suggest practical solutions to help them overcome the problem.”

Suggestions, she added, might include persuading men to let their wives drive for the period of the ban, or exploring local public transport options. It is important, she stressed, to get patients to repeat back the information to ensure that they have understood it. Regular technical check-ups, she added, can provide the ideal opportunity to check whether patients are adhering to advice and to reiterate the message. 

Digital pen technology

Issuing heart failure patients with special digital pens, incorporating the facility to transmit data via mobile internet technology, might offer a cost effective way for nurses to remotely monitor symptoms and helps patients take ownership of their condition, suggest Swedish researchers.

The approach, highlighted in Saturday’s session “Health technology and patient safety’, offers an example of how new technology can facilitate nurses in their day to day management of patients.  Anna Strömberg, a researcher and heart failure nurse specialist from Linköping University, Sweden, who is piloting the project together with Leili Lind, a researcher from the Department of Biomedical Engineering, explains: “Telemonitoring, where telecommunications equipment allows patients to be monitored on a daily basis, has become increasingly popular in heart failure. But equipment, including scales, blood pressure and ECG monitoring devices incorporating special communications features, can be very costly.”

The pilot project, she explained, involves issuing heart failure patients with the AnotoTM digital pen, which to all intents and purposes looks, feels and functions just like an ordinary ball-point pen. The difference, however, is that pen strokes are recorded and transferred via wireless internet technology directly to servers located at home care services.  In the project patients will be asked to measure weight and blood pressure using devices that they already have in the home, to rate symptoms of breathlessness on a scale of 1 to 10, and to report on intake of medication. The pen, which patients use to record results, costs just € 300.