Heart Health in America: A Continuing Concern

Health visitor using stethoscope to check senior man's heart health during home visit

The short-term effects of the pandemic are being realized while the long-term impact needs to be learned. How can nurses support patients and their cardiovascular health?

Despite the ongoing prevalence of the COVID-19 pandemic, especially the severe ebbs and flows of community-spread that have occurred, heart disease continues to be the leading cause of death in the United States.

The nation’s #1 killer

According to the most recent statistics from the U.S. Centers for Disease Control and Prevention (CDC), approximately 659,000 people in the U.S. die annually from heart disease, or one death per every four deaths. Heart disease also costs the healthcare industry approximately $363 billion each year, including the cost of healthcare services and medications.

Coronary artery disease (CAD) is the most common type of heart disease, killing 360,900 people in 2019 alone, according to the CDC. Additionally, approximately 18.2 million adults ages 20 and older live with CAD and approximately two in 10 deaths from CAD occur in adults who are younger than 65 years old.

Related: Cardiovascular Specialty CE Courses for Nursing Professionals

COVID and heart disease

The pandemic has in no way reduced the need for awareness of heart health. To the contrary, it has enhanced the need for nurses and other providers to be more vigilant.

The healthcare community has yet to understand exactly how COVID — and its direct clinical consequences, as well as its impact on stress and hypertension — will affect people of various ages and ethnicities long term, says Yvonne Commodore-Mensah, PhD, MHS, RN, FAHA, FPCNA, assistant professor, community-public health nursing at Johns Hopkins School of Nursing.

“The pandemic has caused some disruptions in healthcare where people are fearful of being seen in person,” said Commodore-Mensah. “And that happened very early on. It’s important that [nurses in particular] help patients to understand that they should not miss appointments due to fears about COVID so that we can avoid the types of cardiovascular events that we are trying to prevent. Timely care is of the essence. And we have to encourage patients to be aware of the things that they can do to promote their heart health despite the pandemic.”

For those patients who are already diagnosed with heart disease, there is a higher likelihood of death and severe sickness if they were to contract COVID. “For those patients who survive, they are more likely to live with complications and need further hospitalization because their body is already in a state of inflammation,” said Commodore-Mensah.

Related: Cardiovascular Nursing: A Comprehensive Guide to Patient Care

Taking steps to stay healthy

Nurses can take certain specific steps to give their patients a better chance to remain heart healthy during the pandemic:

  1. Remember that telehealth is still a viable option. This is an effective way to see patients to ensure that they are being cared for in a timely manner, are taking their medications, and are monitoring their blood pressure regularly.
  2. Nurses should emphasize that patients should not neglect their heart care. “There is evidence that people are not seeking care and that deaths are happening that are not related to covid because patients are fearful of catching COVID,” said Commodore-Mensah. “We have seen excess deaths that are not attributed to COVID, and one of the leading causes is cardiovascular disease. People may be running out of medications, for example, and need their healthcare providers to help them to be sure that they are practicing self-care.”
  3. Advance the state of health equity. Nurses can promote diversity, equity, and inclusion while advocating for equitable access to healthcare for their patients.
  4. Maintain an overall understanding of patients’ social determinants of health. “Because we are in the middle of a crisis and it seems like people are on different trajectories,” said Commodore-Mensah, “as nurses, we need to take the time to understand each patient’s unique context. If someone is missing appointments, we need to understand why. Is it transportation? Is it childcare issues? Is it food insecurity? We need to assess our patients’ social needs to understand why they might not be adherent. And nurses need to embrace the differences of what their patients are living through.”
  5. Promote the “Life’s Simple 7” strategy from the American Heart Association, including the management of blood pressure; control of cholesterol and blood sugar; maintaining regular physical activity; eating a healthy diet that is low in saturated fat and sodium and high in fruits and vegetables; losing weight; and smoking cessation.

Looking ahead

As the lingering effects of the pandemic play out, Commodore-Mensah expects that nurses will continue to see patients who are generally sicker. For example, people who do not currently have an existing disease could develop diabetes due to contracting COVID.

“Death is only one outcome of the pandemic,” said Commodore-Mensah. “We are still accumulating evidence and data, and we will understand more in the coming years. There are some things that we can’t say with certainty because people have not lived long enough with the disease yet to know all of the long-term consequences.”

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