Christina Blaesing, FNP-C

Recent statistics reveal that 85.6 million Americans live with cardiovascular disease (CVD) or residual deficits from stroke. In the United States, CVD is the cause of 1 in 3 deaths and an estimated $320 billion in health care costs and lost productivity in 2011.

The basis of primary prevention includes screening for modification of CVD risk factors (eg, diet, smoking, hypertension, dyslipidemia, physical activity, obesity, and diabetes). Utilizing evidence-based practice in the management of chronic disease is essential to improving outcomes. Retail health clinicians can influence care outcomes at both of these levels.

Knowledge of past medical history, current medication list, and allergies is essential in treating patients with CVD comorbid conditions. A patient presenting to the retail health clinic with lower respiratory infection, treated hypertension, and obesity, who is also a current smoker, will be managed differently than a patient without these comorbid conditions. Every encounter presents a unique opportunity for the clinician to not only treat the acute episodic condition, but to further partner with the patient for consideration of smoking cessation and lifestyle changes to promote weight loss and lower blood pressure.

Many prescription or OTC medications have serious interactions with common cardiovascular medications or conditions that can cause harm to the patient. Several antibiotics should be avoided when treating a patient who is currently on cardiovascular medications, such as beta blockers, diuretics, or anti-arrhythmic medications. Azithromycin can cause increased hypokalemia or QT prolongation, both of which can increase the possibility of cardiac arrhythmias. OTC cold preparations that contain pseudoephedrine can interact with antihypertensive medications, causing a dangerous increase in blood pressure.

Clear communication between the retail clinician and the patient’s primary care provider enhance care coordination and follow up.

Acute illness can exacerbate previously stable or unknown CVD and cause a life-threatening crisis. Common CVD diagnoses include angina, pulmonary emboli, hypertensive or hypotensive urgency, and cerebrovascular accident. See the

for risk factors and warning signs of these acute processes. Activation of the emergency response system is critical to the patient’s survival. With timely provider triage and appropriate use of automated external defibrillators and oxygen, clinicians can apply life-saving interventions while awaiting arrival of emergency medical services.

Every encounter offers the opportunity to promote prevention or management of CVD. Encounters for physicals or acute episodic illnesses can identify cardiac issues (abnormal heart sounds, elevated blood pressure), lifestyle habits (eg, smoking, overuse of caffeine or high energy drinks, recreational drugs, alcohol use), or conditions that contribute to CVD (diabetes, obesity, inflammatory conditions).

The retail health clinician can begin or reinforce disease management with follow- up by the patient’s primary care provider or specialist. Timely use of motivational interviewing can help to solidify smoking quit dates and dietary, activity, or chronic disease management behavior changes.

Table: Common Cardiovascular Disease Diagnoses

Age/gender (highest incidence in men under the age of 70 years and postmenopausal women)

Family or personal history of cardiac event before age 55

Chest pain;  may radiate to arm, jaw, back, abdomen

Chest pain with exertion, exposure to cold, or stress

History of blood clots or deep vein thrombosis

Family or personal history of elevated blood pressure

Gender (men until 45 years of age, women after 65 years of age)

Collaborative efforts between retail health care clinics and larger health care systems allow for improved communication and coordination of care. Board-certified providers in retail health offer convenient, accessible, and affordable care located close to the patient’s home. Telehealth

and partnering with a health system’s emergency care, primary care, specialty, and other service networks are enormous opportunities for growth. Electronic medical record systems with the capability to share data are critical to care coordination. Evidence-based protocols for screening and management of CVD are utilized by retail health clinicians as patients present to their clinics for acute, episodic encounters or management of chronic disease.

Retail health clinicians have a unique opportunity to promote primary prevention, management, or co-management of CVD, and improve patient outcomes.

As clinical educator for Healthcare Clinics at Walgreens, Karen Brautigam, FNP-C, enjoys the opportunity to develop program materials and coach best practices for implementation of new and existing services. Karen’s extensive professional experience includes care of patients across the lifespan in hospitals, home services, long-term care, and primary care. Karen graduated from the nurse practitioner program at St. Louis University (adult) and Maryville University (family). She enjoys the challenge of being a member of the adjunct nurse practitioner faculty at St. Louis University, as well as working in research and leadership roles.

Christina Blaesing, FNP-C, worked as an orthopedic and critical care nurse for over 10 years. Upon obtaining her master’s degree as a family nurse practitioner, she helped implement and practice within an orthopedic total joint center working pre-surgical services in collaboration with a multidisciplinary team. She currently works for the Healthcare Clinic at Walgreens as a family nurse practitioner and also mentors new hires as a lead preceptor.

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Articles

Recent statistics reveal that 85.6 million Americans live with cardiovascular disease or residual deficits from stroke. 

Christina Blaesing, FNP-C

Articles

Cardiovascular Disease Prevention & Management in Retail Health