Literature Review
Cardiovascular Disease
Susan A. Hensley
Excelsior College

Abstract
Cardiovascular diseases (CVD) are one of the foremost origins of morbidity and mortality in the United States today, and the rates have grown exponentially over the last few decades. There is a number of health related factors and behaviors that contribute to the onset of CVD and its contribution to other well-known diseases. Implementing appropriate life style changes, certain medications, and education can contribute to the early detection of CVD and can have the potential to modify or alter the course of this deadly disease. Kehler, Christensen, Risor, Lauritzen, and Christensen (2009), reported “that patients who had a discussion with their doctor about cardiovascular disease including information about the disease, knowledge about the disease, and perception of risk and prevention strategies indicated that they were able to incorporate healthy lifestyle changes into their diet”. Through education and recognition, healthcare providers can assist patients in achieving healthy lifestyles and initiate ways to decrease risk factors associated with CVD. The health promotion model (HPM) can be utilized to enhance patients’ awareness for prevention, intervention, and perception of risks related CVD. The contents included in this paper will discuss how CVD is defined medically and through patients’ perspectives; the prevalence of CVD in the United States; precipitating factors of CVD; vulnerable groups of CVD; and a theoretical framework of the HPM for CVD.

Literature Review Cardiovascular Disease
From a medical perspective CVD can be perceived as a continuum of a pathological process, in which the coronary arteries steadily harden and thicken with plaque which obstructs the blood flow. The Centers for Disease Control (CDC) (2013) states,
“Cardiovascular disease (CVD) refers to several types of conditions that affect the heart and blood vessels; many CVD risk factors such as high blood pressure, high cholesterol, excess weight, poor diet, smoking, and diabetes can be prevented or treated through health behavior change and appropriate medication. Some unpreventable risks for CVD are related to heredity, medical history, age, gender, and race and also a number of underlying social, economic, and cultural determinants of CVD such as stress, education level, income, and insurance status”.
Patients’ living with CVD has various perspectives on the disease and the process. Evaluations have shown that patients who live with CVD it can be terrifying, constricting and stressing for the patients as well as their family. Patients have found it more difficult when dealing with functional limitations and adjusting to living with CVD. These patients also have specific complications due to co-morbidities, certain adverse reactions of medications, and an insufficiency of psychosocial assistance and treatment services. According to Anyadubalu (2010),
“Patients had similar experiences of physical signs and symptoms of CHD from time-to-time which ranged from chest discomfort, discomfort/pain on the legs, waist, ribs, stomach, joints, jaws, back bone, throat and back-neck-bone, tiredness, fatigue and loss of energy, shortness of breath, feeling of dizziness, headache, inability to perform their normal duties effectively to signs of overweight. All the CHD patients had past serious medical conditions – asthma, overweight, lower/irregular heart rate/beat, blood heart disease, high BP, lungs, kidney or spinal cord problems, leg or back bone pains, diabetes or gout/arthritis – for which they had been receiving medications/treatments from their physicians.
Those with fewer socioeconomic and other resources discovered that CVD was harder to manage and cope with. Patients from certain ethnic and diverse groups had different views and attitudes about the disease and its treatments, and many had extreme difficulties communicating with healthcare providers which made coping with the disease more challenging. A study conducted by Anyadubalu (2010) stated, “On the average, patients experienced intense fear, anxiety, worry and depression, while a few others continued to experience normal state of mind on hearing the news of their positive CVD status”. When caring for a family member with CVD, there are often conditions that can have a considerable effect on the physical health and psychological aspect of caregivers. Psychosocial assistance and rehab services offered at diagnosis and following an acute event would empower families the opportunity to improve upon the management of living with the disease.
With CVD having various forms, it is considered to be the number one killer in the United States and is also a major source of disabilities. According to the CDC (2013),
•About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.
•Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men.
•Coronary heart disease alone costs the United States $108.9 billion each year. This total includes the cost of health care services, medications, and lost productivity.
Several research studies have shown that there are specific groups that tend to be more vulnerable for CVD than others. Key risk factors for CVD include, but not limited to, are smoking, insufficient activity/sedentary lifestyle, high blood pressure, and increased cholesterol levels. According to the CDC (2013), “About half of Americans (49%) have at least one of these three risk factors”. There are a number of other lifestyle choices and medical illnesses that may furthermore place individuals at increased probability for CVD, which includes smoking, diabetes, poor diet, excessive alcohol use, and obesity.
The health belief model that was published in the early 1990’s by Nola Pender, “proposes a framework for integrating nursing and behavioral science perspectives with factors influencing health behaviors” (Pender, Murdaugh, & Parson, 2011). It has been extensively recognized that CVD prevention and the associated outcomes are vastly dependent on the behavioral and biopsychosocial factors. Health promotion can result from these components when focusing on an individual’s behavioral changes when adopting and abiding by healthy lifestyle practices. Health promotion and proper education by nurses and other healthcare professionals can be considered a prime element when promoting effective changes and developing a healthy lifestyle.
When applying the HBM to CVD, decreasing the risk factors can improve or prevent one from developing the disease. However, when trying to prevent the CVD one must also believe that he or she is at risk, which many people fail to acknowledge. Patients are encouraged to take responsibility of their health by working with healthcare providers to address specific risk factors such as increased blood pressure, abnormal cholesterol levels, weight issues, and other unhealthy lifestyle habits. Reducing the risk of CVD typically requires making healthy lifestyle choices and adhering to them. However, “Changing harmful health-related behaviors in clients at risk of disease is not always straightforward, particularly when the only intervention is the provision of rigid biomedical health education and advice”, (Paniagua, Reilly, Evans, & Bond, 2011). For patients to be encouraged to prevent and develop interventions they need to recognize and comprehend the disease process, feel dedicated enough about the condition and be willing change it, feel competent enough in changing the situation by having knowledge, support, and life changing skills. “Risk assessment tools may provide a more realistic picture of an individual’s absolute and relative risks and improve the accuracy of perceived personal risk”, (Gholizadeh, Davidson, Salamonson, & Worrall-Carter, 2010).
Conclusion
As described earlier, the assessment and awareness of risk is complex and expands well beyond presenting information. There is a limited association between healthy behaviors and knowledge, and these healthy behaviors are influenced by factors such as individualized, social, ethnic, and cultural influences. Evaluating the correspondence between perceived and actual risk factors is a vital step in developing efficient and successful care plans to decrease CVD. Identification of factors influencing on the correct perception of risk for CVD has substantial effects on the execution of successful nursing interventions. Pursuing patients with a greater risk for incorrect perception can develop CVD strategies for primary, secondary and tertiary risk. Emphasizing the need to improve upon the accuracy of prevention and intervention of the risk of CVD is to consider not only the patient as an individual but also the biopsychosocial factors as well. Nurses as well as healthcare providers are in unique and distinctive positions to evaluate the effectiveness of risk factor perception while presenting education, behavior, management, and treatment strategies, and with the HPM these should be essential stages in developing and creating effective and essential nursing treatment strategies.

References

CDC. (2013). Retrieved 2013, from Centers for Disease Control: http://www.cdc.gov/heartdisease/facts.htm
Anyadubalu, C. (2010). The experiences of coronary heart disease patients: biopsychosocial perspective. World Academy of Science, Engineering and Technology, 67: 132-142. Retrieved from Excelsior Library May 14, 2013.
Gholizadeh, L., Davidson, P., Salamonson, Y., & Worall-Carter, L. (2010). Theoretical considerations in reducing risk for cardiovascular disease: implications for nursing practice. Jouranl of Clinical Nursing, 19, 2137-2145. Retrieved from Excelsior Library May 14, 2013.
Kehler, D., Christensen, M., Risor, M., Lauritzen, T., & Christensen, B. (2009). Self- reported cognitive and emotional effects and lifestyle changes shortly after preventive cardiovascular consultations in general practice. Scandinavian Journal of Primary Health Care, 27: 104-110.
Panizgua, H., Reilly, C., Evans, J., & Bond, P. (2011). Driving health promotion into the community: an initiative evaluated. British Journal of Nursing, Vol. 20, 862-865. Retrieved from Excelsior Library May 14, 2013.
Pender, N., Murdaugh, C., & Parsons, M. (2011). Health promotion in nursing practice. Upper Saddle River, NJ: Pearson.