Abstract
Coronary heart disease has remained a scourge despite the fact that relentless efforts of therapy have always been put in place. One of the major concerns worth considering is the issue of aspirin failure. There are numerous recommendations of implementing interventions which will help in preventing primary and secondary events of CHD. This paper uses medication intervention outcome analyses to illustrate how dietary as well as lifestyle changes are instrumental in dealing with coronary heart complications.
Introduction
The American Heart Association (AHA) and the American College of Cardiology foundation (ACCF) have done clinical trials on post therapy risks. Their efforts have been important in broadening the advantages accrued from intensive reduction of risks after treatment. This has been particularly witnessed in therapies for patients who have coronary or other atherosclerotic vascular maladies. According to Aschenbrenner and Venable (2009), aspirin failure in treatment of illnesses such coronary syndromes has continually been on the rise. Indeed, there are occurrences of acute coronary diseases such as carotid, peripheral artery diseases and atherosclerotic aortic diseases. Risk reduction therapies and secondary preventions are necessary for patients with these diseases. There is a varied and adequate body of evidence which confirms the comprehensive risk factor that manifests itself in medication failure when using aspirin.
Aspirin is believed to significantly reduce blood vessel thrombotic malfunctions. Apparently, coronary diseases are still prevalent. This can be largely attributed to a case scenario known as “aspirin failure”. Recommendations made on dietary and lifestyle changes have proven to be more reliable. Besides, health care providers have embarked on this important way of reinstating coronary disease patients. The impetus for dealing with aspirin failure has led to the formulation of broad-based policies. This clinical failure of aspirin is related with increased cardiovascular risks in aging, hypertension and diabetes, previous heart attacks and revascularization (Baliga, Pitt & Givertz, 2008).
The most recent study reveals that failure of aspirin comes with worsening prognosis of coronary diseases (Domino & Baldor, 2012). It becomes perpetually impossible to come up with a drug which can bring some significant effect to patients in order to reduce subsequent occurrences of the disease. On a different note, aspirin failure may be as a result other factors on top of normal drug resistance. It is yet to be decided whether platelet characteristics are to be worked on. Granato (2008) proposes that patients should continue being guided through the necessary lifestyle modifications. This should be integrated with dietary solutions such as emphasis on consuming vegetables, fresh fruits and low fat products. The purpose of this project in my practice is to help to patients with coronary heartdisease to improve and get results with feasible changes in their life style and diet. It is also supposed to accredit the base of my study on aspirin administration, lifestyle and dietary changes.
Background and significance
Relationship between clinical outcomes and aspirin failure can be demonstrated accordingly. Aspirin failure is explained with an occurrence of coronary syndromes despite continued use of aspirin. This is also associated with failure of platelet inhibition and various manifestations in patients. An evaluation about 170 patients shows that 118 are aspirin naïve and the rest have aspirin failure (Wiviott & American Heart Association, 2009). This is a ratio of 60% to 40 %. It is clear that this is a high number of cases of failure. An analysis of platelet functioning before and after aspirin medication shows that patients with aspirin failure record lower platelet aggregation in the following ranges; (32 versus 45, p = 0.003). These change accordingly after following aspirin therapy (Wiviott & American Heart Association, 2009).
After conducting an analysis of major coronary events, the following statistics have been illustrated (this was only done in major health concerns like stroke, death and acute CHD). Patients with aspirin failure were the most affected. One, they seem older (=0,002), two, they are hypertensive (p<0.001) and three they have more lipid and fat (p>0.001) (Wiviott & American Heart Association, 2009). In summary, aspirin failure is a symbol of increased risk to coronary heart diseases. It is not a problem of platelets like it has been perceived before.
Literature review
Reports from the American Heart Association have been resourceful in gathering information on coronary diseases. Findings show that despite efforts on secondary prevention, coronary diseases of the heart are prevalent among over 50% of the aged women and over 70% of elderly men (McDonagh, 2011). Most cases are obstructive artery diseases. In many nations, coronary heart disease in persons above 60 years is between 2-3% of given populations (McDonagh, 2011). The problem escalates even further with a close address from medical sectors of these nations. On top of this, there is enough information which shows that blood pressure complications keep on risking the lives of patients.
Lifestyle changes may be considered inappropriate for some of these patients due to the fact that their conditions cannot necessitate the achievement of a desirable clinical goal. It must be observed that urgent and more pragmatic measures ought to be devised to help patients with chronic coronary heart disease. Shepard (2010) shows that treatment in the acute stage has failed since cases of secondary attacks are rampant. Aspirin failure comes out as one of the significant issues which demand analysis. Patients presented with cases of aspirin failure have more adverse cases of coronary heart disease than it could be imagined. It has been found out that they bestow a high risk profile of a myriad of cardiovascular malfunctions (Sorrentino, 2011). This is a problem in old age which incorporates hypo and hypertension. Presence of excess fats in the body is also experienced.
Another important finding is that patients with aspirin failure have low platelet responses to aspirin (Vlodaver, Wilson & Garry, 2012). This is a novel finding given that it shows the risk factor of the phenomena. Aspirin naive patients should therefore not be exposed to this kind of treatment. It is recommended that changes in lifestyle will give a more desirable baseline for appropriate action to be taken. Laboratory demonstration aspirin resistance is an adequate sign of a call for more forms of strategic therapies.
Method of research
Visits to clinics which give treatment to coronary disease patients proved an effective way of gathering dependable data. It also helped in coming up with a knowledge which could assist to reduce mortality rate as a result of coronary events. In addition, it was possible to get data from several sources. The research was exclusive to other heart conditions which are not directly related to blood vessels.
There were several steps taken in planning for how to do this patient outcome project. A registry was first combined for the sake of defining feasibility assess and to set a workable scope of operation. This was done according to determinants of the study size and a predetermination of restricted eligibility of charts and data representing about changes with aspirin, healthy lifestyle and diet plans.
Coronary disease program outcomes were gathered from several institutions. This was done with an intention of making use of a large cohort. Data was drawn from similar studies which have been approved by IRB’s. Policies and statements of AHA gave a representation of all measurable exposures in regard to coronary and heart events. Dependent variable (DV) was applied to give the relationship between lifestyle changes, dietary changes and risk factors of coronary heart disease. This included measuring outcomes of strategic plans which have been put in place at different parts of the health system. Outcomes of physical activity and dietary interventions were given the following figures; Bi monthly monitoring records that showed the changes in the cholesterol levels and weight of patients under therapy. Physical activity amounts compared to the levels of improvement shown by patients. An analysis of variance (ANOVA) here was meant to show the difference between physical therapies and pharmaceutical treatment using aspirin.
Recommendation for Implementation
Lifestyle changes at different ages are necessary. In case of the elderly, it is important to come up with methods of avoiding aspirin resistance. In order to devise ways of curbing secondary cases, it is critical to give undivided attention to lifestyle changes. Sorrentino (2011) notes that lifestyle changes are advised as a basic way of preventing coronary heart diseases (CHD). The following is a table which shows appropriate changes.
Figure 1. Lifestyle changes to be advised for secondary prevention of CHD. Source: Sorrentino (2011).
The more “+” symbols, the stronger the advice.
† means the presence of hypertension (in presence of heart failure, this should be advised at all ages).
Body Mass Index (BMI) in kg/m2
Cases of being overweight among those who are quite elderly are a sign of positive prognosis. This explains why advice to lose weight should be restricted to the ones who are elderly. Exercise is recommended to anyone who has the ability to do it. Young patients often do a lot of exercise and are likely going to record significant success in this program.
It has been found out that dietary changes are relatively difficult to implement. Patients tend to develop compromise in dietary therapies. Cholesterol levels are mainly lowered by diet adjustments than by exercise. Reduction in consumption of ions is significant in the regulation blood pressure among the elderly. Stopping smoking has an immediate advantage in prevention of coronary heart disease (Sorrentino, 2011). Within one year of abstaining from smoking, a patient gains high level of health. Moreover, an improvement in respiratory complications will be attained.
Estimated impact of secondary prevention and risk reduction therapy
It is true that coronary heart disease remains a serious burden to many nations. Despite this enormous problem, mortality rates caused by this health complication were able to go down by about 35% in the period of ten years preceding the year 2000 (Wiviott & American Heart Association, 2009). Statistical models reveal that this was attributed to secondary prevention and risk reduction therapies. High numbers of cases of severe coronary syndromes were reduced through the use of lifestyle modification rather than pharmacotherapy. Conventional risk factors like hypertension and cigarette smoking were declined accordingly.
Through the help of cardiovascular care providers many persons have been able to achieve lifestyle changes which have enabled them to progress well in terms of their health. This is observed through loss of weight for the obese and control poor eating habits. Importance of exercise structured interventions is that they bring about the desired effect without the involvement medications like aspirin.
On the other hand, dietary recommendations help in balancing energy expenditure and energy intake in the body. This is a very helpful element in the reduction of risk factors. A basic application for dietary recommendations is having an objective of maintaining a healthy weight. A diet which is rich in fish fiber, whole grain, fruits which taken with reduced salt levels and fat is recommended. This gives the body a foundation to continue functioning in the normal metabolic rate (Granato, 2008). Shepard (2010) notes that such protective diet practices are important in building a normal body. Further research also shows that intake of cardio protective diets maintain the stability of a person’s cardiovascular system. On this note Domino and Baldor (2012) illustrate how vegetables and nuts are essential parts of a healthy diet. Analyses of these modest forms of diet substantially minimize the chances of getting cardiovascular events.
Medical costs incurred as a result of coronary diseases of the heart and the vascular systems decline with the use of secondary preventive interventions. This is not the case in occasions where patients have experienced aspirin failure. Indeed, persons have embarked on a technique of using other supplements to combat the disease. These include the consumption of omega- 3 from marine sources (Baliga, Pitt & Givertz, 2008). Fish has been reported as one of the main interventions used by person to achieve lower levers of lipoproteins. In a global analysis it has been found out that stroke and cardiac death rates are compatible through dietary changes.
Summary
It is evident that people will continue to experience cardiovascular diseases as a result many reasons. It will be illogical if all cases of secondary coronary events are attributed to failure of medication. Epidemiological studies have proven that low levels of physical activities play a major role in the enhancement of all risk factors (Granato, 2008). Cardio respiratory fitness has a direct relationship with mortality rates due to coronary events. Reviews show that in about one million people, risk is minimized by as much as 35% if exercises and dietary interventions are put in place as required. Metabolism in both women and men can be mastered to operate at a desirable range. This affects the prognosis of coronary heart disease. Conditions of morbidity are disoriented and hence better health is achieved.
In a collective manner, data exhibited here suggests that patients should be counseled to adopt lifestyles full of physical activity. This is intended to help individuals to move out of absolute dependence on medicine (Shepard, 2010). The compounded risk of coronary heart syndromes and other cardiovascular diseases is comparable to these interventions. They have a linear relationship. It is clear that the risk of this malady decreases as physical activity is increased. There is significant risk alienation when an optimum rate of aerobic capacity is maintained. At levels beyond what is possible or achievable by a patient, risk reduction becomes parallel to increased physical activity. Attaining cardio respiratory well being is thus demonstrated as a resourceful element of therapy. This relationship is demonstrated in figure 2 shown below.
It should also be noted that lifestyle changes and drug therapy of CHD and other related maladies have an additive and independent relationship (Shepard, 2010). The effects of both drug therapy and lifestyle changes relate as shown in table 1 below;
Overall dietary and lifestyle changes have the highest risk reduction effect. The compounded effectiveness of smoking cessation, ACE inhibitors, physical activity, moderate alcohol and use of aspirin are lower according to this given study (Aschenbrenner & Venable, 2009).
Needless to say, the possibility of being involved in a particular behavioral change is determined by several factors such as culture, attitude and social economic factors. The expectation of effects of the new behaviors consequences, costs and effects play a very important role. They determine the scale of achieving a person’s set goals and objectives. Studies of behavior show that change in lifestyle has abrupt modulations which contradict the expectations of people. Achievement of health behavior is comparable to running a marathon. Attitudes of hitting the target in a short while after getting a specific medication need to be dismissed. The ultimate to success in cardiovascular health is exercise of utter persistence in the case of both health providers and patients.
Suitable and highly effective therapy will come with physical activities, lifestyle changes and dietary adjustments. Currently, good interventions are the ones which promote these population based strategies. They are devised in a manner which cannot be compromised by effects of unnecessary aspirin failure. These methods of therapy have to be reinforced with physician’s help in training and motivation. Health care systems have a task of making policies which create a flat form for effective interventions. There is high number of issues which have to be streamlined in a bid to support such interventions. These range from creating awareness to everyone (both patients and patient’s caretakers) to the provision of quality guidelines which explain the problems that are usually associated with coronary heart diseases.
Patients have to be directed towards the adoption of personalized interventions. Given the current trend of activities in the system, therapy has to be tailored in a manner that it circumvents and attenuates any factors which play against adherence to treatment. The American Heart Association has managed to give an adequate summary of the impact of several means of dealing with coronary heart diseases. This is important in setting goals and objectives of treatment. These are inseparable with adequate physical exercise and healthy diets. Vigorous activities are supposed to be incorporated in people’s lifestyle as an important health seeking behavior.
In summing up, it is imperative to reiterate that the advantages of cognitive strategies of bringing in behavioral change are supposed to be set in relation to set goals. To buffer the effects of secondary occurrences of diseases, specific actions have to be put in place. Patients ought to be equipped with skills. Prevention of relapse, solving problems, modeling, incentives, self efficacy, ability to attend follow up sessions and a culture of monitoring oneself. Giving patients a task to observe other individuals who are undergoing similar behavioral change is essential here. Clinicians who have decided to evade the threats of aspirin failure should communicate understanding to the societies they live in.
References
Aschenbrenner, D. S. & Venable, S. J. (2009). Drug therapy in nursing. Philadelphia: Williams & Wilkins.
Baliga, R. R., Pitt, B. & Givertz, M. M. (2008). Management of heart failure. London: Springer.
Domino, F. J. & Baldor, R. A. (2012). The 5-minute clinical consult 2012. Philadelphia: Williams & Wilkins.
Granato, J. E. (2008). Living with coronary heart disease: A guide for patients and families. Baltimore: Johns Hopkins University Press.
Kwiterovich, P. (2010). The Johns Hopkins textbook of dyslipidemia. Philadelphia: Williams & Wilkins.
McDonagh, T. A. (2011). Oxford textbook of heart failure. Oxford: Oxford University Press.
Shepard, D. S. (2010). Lifestyle modification to control heart disease: Evidence and policy. Sudbury: Jones and Bartlett Publishers.
Sorrentino, M. J. (2011). Hyperlipidemia in primary care: A practical guide to risk reduction. Totowa: Humana.
Vlodaver, Z., Wilson, R. F. & Garry, D. J. (2012). Coronary heart disease: Clinical, pathological, imaging, and molecular profiles. New York: Springer.
Wiviott, S. D. & American Heart Association. (2009). Antiplatelet therapy in ischemic heart disease. Chichester: Wiley-Blackwell.