ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ascvd)
THE USE OF STATIN THERAPY

POPULATION: ADULTS AT RISK FOR ASCVD

RECOMMENDATIONS: PLEASE USE THESE PRACTICE GUIDELINES
USPSTF 2016
ACC/AHA 2018, 2019

The purpose of this assignment is to identify a clinical practice guideline in your specialty area. You will be challenged to evaluate this guideline and discuss its use in clinical practice. This assignment requires a considerable amount of time for completion.
Choose a health problem that you may commonly see in primary care nurse practitioner practice. Describe the health problem and recommend medical management for it. Research published clinical practice guidelines and evaluate the practice guideline you have selected based on the components listed in the Clinical Practice Guideline Template below.
Clinical Practice Guideline Prompts:
HEALTHCARE PROBLEM IDENTIFIED: Briefly describe the health problem you have identified. Include a discussion of morbidity, mortality, epidemiology, and pathophysiology related to this health problem
PRACTICE GUIDELINE: Describe the clinical practice guideline used for this problem. Reflect on the questions included. Expand on your answer using support from evidence

Does the clinical practice guideline adequately address the health problem? Describe.
Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?
Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?
How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.
ANALYSIS: Think about future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.
Does this clinical practice guideline need revision(s)? Please explain your answer in detail.
If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?
How might changes in US demographics and healthcare reform affect this clinical practice guideline?
What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?
EVALUATION How would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.
LEARNING POINTS (3-5 bullet points outlining key learning in this case.)
REFERENCES (APA formatting, current within past 5 years.)

Expectations
Due: Monday, 11:59 pm PT
Length: 8 pages minimum, 12 pages maximum not including the title page, abstract, and reference pages
Format: APA formatted paper – you can opt to use the prompts or a version of the prompt for headers, but do not copy the prompts directly into your paper
Research: APA formatting, current within past 5 years.

 ANSWER

Atherosclerotic Cardiovascular Disease

Healthcare Problem Identified 

The identified health problem is Atherosclerotic Cardiovascular Disease. Atherosclerosis first entails the process in which the coronary arteries, cerebral arteries, and femoral arteries, and the aorta, which is responsible for coronary heart diseases, stroke, and also peripheral arterial disease. The disease could begin when none is a child in the Intimae of the large elastic and muscular arteries. During early childhood, there is no disturbance in the blood flow, but with time the lesions become more and more extensive. Despite multiple advances in medical, and surgical treatment, one of the leading disease that cause multiple deaths  in both developed and underprivileged nations annually is the  atherosclerotic disease.

In the US alone, according to Ladich, Virmani, Kolodgie, & Otsuka (2019), coronary artery disease causes approximately 1 out of every 6 deaths, which accounts for around 400,000 deaths per year. According to the research, an estimated 785, 000 have an initial Myocardial infarction, where 470,000 have a recurrent attack (Ladich, Virmani, Kolodgie, & Otsuka, 2019). The disease remains to be one of the leading causes of death in the Western world. There have been many reports of sudden Cardiac deaths, which is a clear indicator of the atherosclerotic process, which occurs in >450,000 persons yearly. According to Ladich, Virmani, Kolodgie, & Otsuka ( 2019), there is approximately 80% of Coronary Thrombosis in women who are older than  the age of 50 where the incidences surge with age. ASCVD has been established to be the leading cause of morbidity and mortality globally. In the US alone, it is the leading cause of death for persons from racial/ethnic groups, where an estimated cost of >$200 billion is used per annum in healthcare services, medications, and lost productivity (Ladich, Virmani, Kolodgie, & Otsuka, 2019). This can be attributed to suboptimal implementation of prevention strategies and uncontrolled ASCVD risk factors in most of the adults. According to CDC (2020), cardiovascular diseases, men and women of most racial and ethnic groups are mostly affected. The study shows that every 36 seconds one person dies in the country due to cardiovascular disease (CDC, 2020). The disease hence costs the country about $363 billion annually, where the costs include costs of health care services, medicine, and the lost productivity due to death.

Practice Guideline

The American College of Cardiology (ACC) and American Heart Association (AHA) has been on the frontline in the battle of improving cardiovascular health in the country. The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease provides guidelines that are based on systematic methods of evaluating and classifying evidence, where the guidelines provide a foundation for the delivery of cardiovascular care in the country (Arnett, et al., 2019). The guideline provides endorsements applicable to the patients with or at risk of developing cardiovascular diseases.

The goals of the guideline are to ensure that there is improved quality of care and also help in aligning with the interests of the patients. The recommendations of the guideline include clinical evaluation, diagnostic testing, and also pharmacological and procedural treatments (Arnett, et al., 2019). By adhering to the recommendations in the guidelines, then the health practitioners can help in implementing the most suitable interventions that can help in effectively dealing with atherosclerotic cardiovascular diseases and other associated conditions and comorbidities.

How the clinical practice guideline adequately addresses the health problem

The ACC/AHA 2019 guideline comprehensively addresses the issue of Atherosclerotic Cardiovascular Disease by first giving a glimpse of what the disease entails, how it is acquired, and finally giving the most suitable recommendations on how to effectively deal with the disease (Arnett, et al., 2019). The guideline ensures that there is the use of expertise and personnel from the broader medical community, who give their intellectual perspectives and also the best ways of practice that can help in providing a sustainable solution to the issue of Atherosclerotic Cardiovascular Disease in the country. The guideline entails numerous policies and methods that will ensure that sustainable, solutions towards the issue of cardiovascular disease in the country are addressed. From 2017, there have been numerous modifications to the guidelines, where the modifications continue to date, as a way of ensuring that innovations and inventions that can help address the challenge are in place.

The practice guideline basis on current evidence 

The ACC/AHA 2019 guideline is mainly based on current evidence. According to the guideline, most of the research entails studies undertaken in the last five to ten years, where they have information regarding patients with or at risk of getting the ASCVD disease. The guideline itself was documented in 2019, meaning that it is a recent publication, which can hence be relevant to the current events of the disease (Wenger, 2019). The evidence of the guideline is strong in that it entails an all-inclusive patient-centered approach to address all features of the habits and lifestyles of the patients. It also has the projected risk of future ASCVD events, which aids the caregivers in understanding the need for pharmacotherapy for patients.

The strength of the evidence can be seen through the methodology and evidence review of the guidelines, where it entails a comprehensive and succinct compilation of practical guidance for the primary prevention of ASCVD (Arnett, et al., 2019). The guideline also uses literature derived from research involving human subjects and other selected databases.

How clinical practice guideline directs the healthcare provider in the management of a patient with ASCVD

The AHA 2019 clinical guideline adequately offers guidance to all the health care providers and also the patients on how to manage the patients with the AVCD problem. This is since it goes most suitable guidelines and practices that the caregivers can data when dealing with persons who are at risk or already have the ASCVD disease (Rosenzweig, et al., 2019). It also articulates the most suitable strategies to be adopted for the maintenance of ASCVD prevention. The clinical practice guideline entails a multifaceted approach that supports clinical decision making, where it encourages collaboration between different health care providers, patients, and family members in ensuring that the goals of treating the patient are fully attained.

The guideline navigates for a theme-based approach involving all key stakeholders. Including clinicians to help in the prevention of ASCVD, where it states that this will help in significant improvements in patient outcomes (Rosenzweig, et al., 2019). According to the guidelines, this will help in meeting the ends of the patient, more so in a low-resource setting and also within the vulnerable populations in the communities. The guideline also offers the most suitable model to be used by clinicians, where it advocates for a theme-based care model, which has demonstrated a breakthrough in the prevention of risks associated with cardiovascular disease. It also further advises the clinicians and other caregivers on other successful interventions that can be used in caregiving for at-risk patients which include telehealth monitoring, having follow-up support aids, and patient education (Vernooij, Sanabria, Solà, Alonso-Coello, & García, 2014). Clinical practice guideline also sufficiently directs the healthcare provider on hwo to effectively  manage a patient with this problem, where it advocates for a collaboration between the patient and the clinician as a way of establishing a sustainable solution to the disease.

According to the guideline, by having shared decision making, then a practitioner is easily able to engage the patient in discussion regarding personalized ASCVD risk estimates and the implications for the likely benefits of the preventative strategies. The clinician is also able to discuss with the patient strategies such as lifestyle habits, the goals and also the recommended medical therapies (Nambi & Bhatt, 2017). The guideline advocates for collaborative efforts, since they can greatly help in addressing the possible barriers to the treatment options, as compared to just treating and guiding  the patients without getting their input.

How effective the clinical guideline is in the management of patients with this healthcare problem 

The clinical guideline is effective in the management of patients with AVCD or at risk of getting the disease. This is since, it thoroughly explicates the diseases, how the diseases can be acquired, how they can get prevented, and finally how the caregivers can be able to deal with patients who already have the disease (Virani, et al., 2019). It provides appropriate guidelines both to the patients and the clinicians on the most suitable ways of handling the disease and ensuring that the mortality rates are minimized. As much as there is ace for improvement, the guidelines ensure to engage experts, who are conversant with diseases, who help in providing the most suitable recommendations on the handling of the disease, and ensuring that there is ultimate effective patient management.

Analysis

The need for revising the clinical practice guideline

Despite its thoroughness and comprehensiveness, there is always a need to improve on the clinical guidelines to ensure that it continues to address developing challenges in the fight against Atherosclerotic heart diseases. First, there have been emerging unhealthy trends among the people, in terms of how they eat, drink and live, meaning that more preventative measures need to be addressed in the guidelines to help in among more people aware about their lifestyle, and help them adopt better and more quality behaviors. There is also a need for revising the clinical practice guideline given that scientific knowledge is in constant change, hence a need for regular updating as a way of maintaining its validity (Vernooij, Sanabria, Solà, Alonso-Coello, & García, 2014). With more scientific researches taking place, innovations and inventions regarding the disease will be identified, a factor that will require a revision of the current guidelines in place.

The reason and updating process of the clinical guidelines would entail first identifying new evidence regarding the diseases, before assessing the need to update and precise the guideline. This would be followed by the formulation of new and modified recommendations, to ensure that the guidelines are updated and have a better option for the patients and clinicians to use in the fight against Atherosclerotic Cardiovascular disease. However, an update would need to take place after 3 to five years, to enable in-depth research on the recommended updates.

If you were going to revise this clinical practice guideline, what would you change? 

To revise the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, there would be a need to consider issues to do with behavioral change for all populations as a way of dealing with diseases. The revised guideline would focus on highlighting the recent bad lifestyle habits that people, have adopted and that would be major risk factors to the disease. The guideline would also highlight the best new preventative measures which would mainly include lifestyle changes such as keeping fit, the type of meals that one should constantly eat, and the behaviors that ought to be avoided from childhood to help prevent the disease.

How might changes in US demographics and healthcare reform affect this clinical practice guideline?

Changes in the Us demographics and health care reforms in the country are likely to affect the clinical practice guideline. It is manifest that there has been a recent demographic shift, a factor that greatly affects the US health care system, both in terms of delivering care and the practice of nursing. This hence affects how caregivers offer services to patients with cardiovascular diseases, a factor that will require changes in the clinical guideline. The changing demographics will mean that more people are getting older and face higher risks of contracting cardiovascular disease. According toa report by Campbellsville University (2014), it was estimated that by 2020, more than 20-% of the population would be 65 years and older, where individuals over the age of 85 would make up the fastest-growing group. As a result, there is more demand for extended treatment for long-term chronic conditions, a factor that is likely to challenge the health care system’s ability to provide efficient care (Campbellsville University., 2014). Therefore, revising the clinical guideline is vital in helping to address such changing demographics and ensuring that sustainable solutions are in place to help deal with the challenge of cardiovascular diseases (Mosadeghrad, 2014). Health care reform, in the country, are also likely to greatly affect the clinical guidelines meaning that revising or updating it will help in integrating the reforms.

Strategies to use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice

After the revision and updating of the clinical guidelines, there would be a need for a plan to ensure that the guideline is adopted and accepted by not just the practitioners but also by all involved stakeholders. First, would entail a need for having awareness and education programs. They would be vital in ensuring that every involved individual nor party is conversant with the changes in the guideline. This is to be followed by involving everyone stakeholder in the implementation phase. The phase would include taking part in educating the at-risk patients about cardiovascular disease, both at their homes and also at the medical facilities (Mosadeghrad, 2014). Involving the at-risk patients in lifestyle changes would entail commitment, more so from the caregivers, as a way of encouraging opposite lifestyle changes to minimize the cases of cardiovascular disease in the country.

Evaluation

As a way of assessing the effectiveness of the clinical guidelines, there would first be a need to identify a clinical area that promotes and follows up the clinical guidelines and practices. The reason for selecting a specific area is to be able to easily identify the prevalence of the identified conditions and also be able to understand whether the guideline has any impact in dealing with the issue (Semlitsch, Blank, Siering, & Siebenhofer, 2015).  This is followed by having an interdisciplinary evaluation group to be in charge of evaluating the effectiveness of the guideline. The advantages of using a group in the evaluation processes to ensure that there is team work reduced bias in the evaluation process and increased awareness of the revised guideline.

Psychometric testing can be used as one of the ways of assessing the efficiency of the revised guideline. This entails a tool that can be used to identify how efficient and efficient the guideline is in addressing the issue of cardiovascular disease in the country. The testing entails the assessment of a better experience, where there is the use of purposively-sampled testers with different experiences in guideline quality assessment (Semlitsch, Blank, Siering, & Siebenhofer, 2015). Undertaking interviews and surveys from both the patients and the caregivers on their opinions and views about the revised clinical guidelines could also be another efficient way of assessing whether the new guidelines will offer better and more sustainable solutions to the issue of cardiovascular diseases in the country.

References

Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., & Ziaeian, B. (2019). 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. a report of the American College of Cardiology/American Heart. a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 74(10), e177-e232.

Campbellsville University. (2014). How Demographics Affect Healthcare and Nursing Practice. Retrieved from https://online.campbellsville.edu/nursing/how-demographics-affect-healthcare-and-nursing/

CDC. (2020). Heart Disease Facts. Retrieved from https://www.cdc.gov/heartdisease/facts.htm

Ladich, E. R., Virmani, R., Kolodgie, F., & Otsuka, F. (2019). Atherosclerosis Pathology. Retrieved from https://reference.medscape.com/article/1612610-overview#a2

Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International journal of health policy and management, 3(2), 77.

Nambi, V., & Bhatt, D. L. (2017). Primary prevention of atherosclerosis: time to take a selfie?.

Rosenzweig, J. L., Bakris, G. L., Berglund, L. F., Hivert, M. F., Horton, E. S., Kalyani, R. R., & Verges, B. L. (2019). Primary prevention of ASCVD and T2DM in patients at metabolic risk: an Endocrine Society clinical practice guideline. . The Journal of Clinical Endocrinology & Metabolism, 104(9), 3939-3985.

Semlitsch, T., Blank, W. A., Siering, U., & Siebenhofer, A. (2015). Evaluating guidelines: a review of key quality criteria. Deutsches Ärzteblatt International, 112(27-28), 471.

Vernooij, R. W., Sanabria, A. J., Solà, I., Alonso-Coello, P., & García, L. M. (2014). Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks. Implementation Science. 9(1), 1-9.

Virani, S. S., Akeroyd, J. M., Ahmed, S. T., Krittanawong, C., Martin, L. A., Slagle, J., & Petersen, L. A. (2019). The use of structured data elements to identify ASCVD patients with statin-associated side effects:. insights from the Department of Veterans Affairs. Journal of clinical lipidology, 13(5), 797-803.

Wenger, N. K. (2019). Female‐friendly focus: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Clinical cardiology, 42(8), 706.