Introduction
At Vila Health, heart diseases are some of the most common health issues that nurses, clinicians, and other health professionals have to deal with as they are frequently presented. In the United States, acute myocardial infarction (AMI) is associated with a mortality rate of about 30%, with more than 50% of deaths occurring before arrival at health facilities (Virani et al., 2021). Moreover, between 5% and 10% of those who survive die within the first year of the condition’s onset (CDC, 2021). Furthermore, approximately 50% of all patients are hospitalized within the first year of the initial event (Benjamin et al., 2019). Therefore, AMI is the leading cause of death among all the ischemic heart conditions and one of the diseases with the highest mortality rates in the country.
Therefore, there is a need for continuous progress and improvement in the care provided to AMI patients to ensure high quality of life for these individuals after their discharge from the health care facilities. Angina, the telltale sign of low blood flow to the heart, is normally symptomized by agonizing pain radiating from the chest down towards the left arm. Nurses must understand the complications of the condition and its management and have the ability to provide the appropriate counseling to those coming with the symptoms (Virani et al., 2021). In addition, nurses must have the capacity to provide the appropriate discharge planning to their patients after angina has induced a heart attack requiring hospitalization.
Based on this reason, a PICOT approach is necessary to design a question that will present an evidence-based practice (EBP) for managing PMI at Vila Health. Previous studies have shown that EBP programs improve care management significantly through positive lifestyle changes, such as careful blood pressure management, regular physical activities, cessation of smoking, and attendance at cardiac rehabilitation.
Specifically, the chosen PICOT question is, “What lifestyle effects does a post-myocardial infarction (PMI) program has on the lifestyle of heart attack survivors when given by an RN compared to those who do not receive the management within one year of discharge?” Based on the outline of this question, the components of the PICOT question are as follows:
- P= Patients who have suffered an MI event;
- I= the PMI program overseen by the RN;
- C= patients of MI who do not receive counseling in the post-discharge PMI program;
- O= positive changes in patients’ lifestyle based on adherence to frequent exercise, cessation of smoking, healthy diet, and careful blood pressure monitoring;
- T= within one year of the patients’ discharge from the hospital.
Identification of Sources of Evidence
The post-myocardial infarction (PMI) program is an appropriate and highly effective method for reducing the recurrence of AMI among survivors of the disease following their discharge from health care facilities. Wang et al. (2020) conducted a study to examine the impact of lifestyle changes on clinical outcomes among AMI patients who had undergone percutaneous coronary intervention (PMI). Similarly, Dibao-Dina (2018) investigate adherence to lifestyle, therapeutic, and risk factor control recommendations among post-myocardial infarction patients over six years.
In their study, Sibel and Argon (2018) examine the effectiveness of a training program developed on the health promotion model and individual counseling to impact positive lifestyle changes among AMI patients following discharge. Ekblom et al. (2018) examined the impacts of adherence to physical activities (PA) program on the survival rates among post-myocardial infarction patients following their initial discharge. The study by Hanna et al. (2020) seeks to investigate the perceptions underlining health-related adherence behaviors among patients who had experienced a heart attack, including AMI. Birtwistle et al. (2020) explored the lived experiences of AMI patients and their families, their engagement with physical activity in post-myocardial infarction programs, and the impact of adherence on reducing the chances of recurrence.
Findings from the Articles
While the pharmacological approach remains the most commonly applied intervention for managing patients of MI infarction during and after discharge, it cannot completely reduce recurrence risks. Studies have shown that reducing the recurrence risks requires lifestyle changes that include physical exercise, cessation of smoking, proper and effective blood pressure control, monitoring, and a healthy diet (Bhatta & Glantz, 2019). The above studies prove that adherence to lifestyle changes plays a great role in reducing the risks of occurrence following discharge. These studies support the view that positive changes in lifestyle reduce the chances of AMI recurrence by more than 80%. Consequently, it is imperative to review some of the most recent studies that provide evidence on the effectiveness of PMI programs.
Relevance of the Articles
The study by Wang et al. (2020) was chosen because it examines the specific topic of interest. The research studies by Dibao-Dina (2018) and Ekblom et al. (2018) are relevant to the concept of adherence to recommendations for AMI patients. Regarding the impacts of the training program on the patients discharged after hospitalization with myocardial infarction, Sibel and Argon (2018) seek to evaluate the effectiveness of such an intervention. Birtwistle et al. (2021) examine the lived experiences of the patients of myocardial infarction and their families as they strive to adhere to the guidelines after discharge.
Conclusion
The examined studies prove that EBP programs can significantly improve care management through positive lifestyle changes. The changes include careful blood pressure management, regular physical activities, cessation of smoking, and attendance at cardiac rehabilitation. The PICOT has incorporated these aspects as the intervention in the program to help improve the outcomes at the hospital. The RN will oversee the comprehensive program as an intervention proposal in a change model delivered to the hospital’s cardiac department.
References
Benjamin, E. J., et al. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56-e528. Web.
Bhatta, D. N., & Glantz, S. A. (2019). Electronic cigarette use and myocardial infarction among adults in the US population assessment of tobacco and health. Journal of the American Heart Association, 8(12), e012317. Web.
Birtwistle, S. B., Jones, I., Murphy, R., Gee, I., & Watson, P. M. (2021). “Do what you can with a happy heart”: A longitudinal study of patient and family members’ lived experiences of physical activity post-myocardial infarction. Disability and rehabilitation, 1-10. Web.
CDC. (2021). Heart disease facts. Web.
Dibao-Dina, C., et al. (2018). Patients’ adherence to optimal therapeutic, lifestyle and risk factors recommendations after myocardial infarction: Six years follow-up in primary care. PloS one, 13(9), e0202986. Web.
Ekblom, O., et al. (2018). Increased physical activity post–myocardial infarction is related to reduced mortality: Results from the SWEDEHEART Registry. Journal of the American Heart Association, 7(24), e010108. Web.
Hanna, A., Yael, E. M., Hadassa, L., Iris, E., Eugenia, N., Lior, G., Carmit, S., & Liora, O. (2020). It’s up to me with a little support”–adherence after myocardial infarction: A qualitative study. International journal of nursing studies, 101, 103416. Web.
Virani, S. S., et al. (2021). Heart disease and stroke statistics—2021 update. Circulation, 143(8), e254–e743. Web.
Wang, Y., Xian, Y., Chen, T., Zhao, Y., Yang, J., Xu, B., & Li, W. (2020). Effect of lifestyle changes after percutaneous coronary intervention on revascularization. BioMed research international, 2020(24), 17-23. Web.