2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

[Extract] Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease 1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions. 3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. In addition, assessing for other risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning. 4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss. 5. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. 6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist. 7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. 8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit. 9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion. 10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg

Theory of self-care of chronic illness

The purpose of the middle range theory of Self-Care of Chronic Illness was to capture a more holistic view of patients those with varied or multiple chronic conditions. One of the assumptions of this middle range theory is that there are differences between general health-promoting self-care and illness-specific self-care. A second assumption is that when providers interact with patients, their intention to form a partnership will motivate patients to engage in a level of self-care that can realistically be incorporated into their daily life and lifestyle. The major concepts of the theory are self-care, self-care maintenance, self-care monitoring, and self-care management. The three concepts of self-care maintenance, self-care monitoring, and self-care management reflect a sequence in which the behaviors are logically related to each other. This chapter describes the use of this middle range theory in nursing research, practice, and education

Whose job is it? :Gender differences in perceived role in heart failure self-care

Aim. To describe gender differences in perceived role in heart failure (HF) self‐care and to explore how an individual’s perception of their role influences self‐care behaviours. Specifically, two hypotheses were tested: (1) there are gender‐specific differences in perceived self‐care roles in HF and (2) there are differences in self‐care secondary to a patient’s perceived role. Background. Gender differences in roles are ubiquitous in all societies. Rarely have these roles been examined as they contribute to performance of self‐care in adults with chronic illnesses. Methods. Secondary analysis of three mixed methods studies (n = 99) of adults with chronic heart failure. Data were collected between 2006–2008. Conclusions. Two dominant perceived roles in self‐care were identified: (1) active and (2) passive. These were further categorised according to the degree of independence described by participants in self‐care decision making: (1) primary responsibility (27%), (2) collaboration (22%) and (3) reliant upon direction from others (51%). Relevance to clinical practice. Clinicians are encouraged to assess the individual’s perceived role in HF self‐care as part of the self‐care education process. Understanding patient perceptions of their role may help guide education, which may be particularly useful for those patients most likely to defer to others for HF management advice

Psychotherapieforschung

These guidelines address the diagnosis and management of atherosclerotic, aneurysmal, and thromboembolic peripheral arterial diseases (PADs). The clinical manifestations of PAD are a major cause of acute and chronic illness, are associated with decrements in functional capacity and quality of life, cause limb amputation, and increase the risk of death. Whereas the term “peripheral arterial disease” encompasses a large series of disorders that affect arterial beds exclusive of the coronary arteries, this writing committee chose to limit the scope of the work of this document to include the disorders of the abdominal aorta, renal and mesenteric arteries, and lower extremity arteries. The purposes of the full guidelines are to (a) aid in the recognition, diagnosis, and treatment of PAD of the aorta and lower extremities, addressing its prevalence, impact on quality of life, cardiovascular ischemic risk, and risk of critical limb ischemia (CLI); (b) aid in the recognition, diagnosis, and treatment of renal and visceral arterial diseases; and (c) improve the detection and treatment of abdominal and branch artery aneurysms. Clinical management guidelines for other arterial beds (e.g., the thoracic aorta, carotid and vertebral arteries, and upper-extremity arteries) have been excluded from the current guidelines to focus on the infradiaphragmatic arterial system and in recognition of the robust evidence base that exists for the aortic, visceral, and lower extremity arteries