This second edition guide is a single resource that provides information on multiple national guidelines, recommended treatment goals that pertain to both primary and secondary prevention of cardiovascular disease (CVD), and information on compliance strategies for enhancement of risk factor reduction interventions. More specifically, the Pocket Guide includes information and guidelines on cardiovascular risk assessment and prevention, lifestyle interventions, cholesterol, hypertension, obesity/weight loss, diabetes and smoking cessation. This publication is included in PCNA new member packets.

Over the next decades, there will be a 250% increase in the number of Americans over age 65 and a 350% increase in those over 85 years. In this age group, cardiovascular disease remains the number one cause of mortality. While cardiovascular care is directed by evidence-based guidelines, elderly patients with complex health situations are not well represented. The increasingly common heterogeneity of older adults make extrapolation of results from younger populations less applicable.

Geriatric medicine contains a unique scope of knowledge and care practices needed for this complex group of older adults. Yet, the number of trained geriatricians will be even more sorely outnumbered than cardiologists in the future. Principles of age-associated alterations in physiology, drug metabolism, comorbidity, and poly-pharmacy must be understood to ensure appropriate, individualized therapy for older adults. Under or over-treatment, transitions of care, and other frequent hazards for hospitalized older patients abound and yet are avoidable. Research studies continue to generate new knowledge applicable to the elderly which need venues for entry into the clinical arena.

Cardiovascular fellowship programs are a perfect venue to prepare trainees to care for this cohort. In fact, the ACGME mandates content in ‘managing geriatric patients with cardiovascular diseases,’ yet this directive is without specific content or suggested approaches. The importance of this content will improve the delivery of patient-centered safe and effective care to older adults reducing health and economic consequences of medical errors. Furthermore, exposure to geriatric cardiology may stimulate trainees to pursue this area of clinical investigation and service.

Therefore, our goal is to design, develop and disseminate a universal curriculum to teach concepts of geriatric care and cardiovascular disease in older adults to cardiovascular sub-specialists. The curriculum will synthesize current knowledge of aging physiology and cardiovascular syndromes in the elderly and summarize geriatric concepts which are important for the care of older adults with cardiovascular disease. The curriculum will consist of six (6) educational modules offered in a logical order utilizing a variety of educational strategies (e.g., case-based learning, video/audio, vignettes). Key aspects of the curriculum will include a biannual revision and update, an enduring home at the SGC, support by the ACC, free website access, and linkage to educational training opportunities.

Cardiovascular disease continues to be the leading cause of death in women over age 50 in the United States. Significant differences exist between men and women in the prevalence, incidence, and treatment outcomes of cardiovascular disease, particularly coronary artery disease.

Heart failure (HF) represents a major and growing public health problem. In this regard, HF is counted among the 2 "new" epidemics of cardiovascular disease. (Atrial fibrillation being the other one.) That is, while the prevalence of most forms of cardiovascular disease is declining, the number of patients diagnosed with HF is increasing. As a result, HF represents the most common cause of hospitalization in those older than the age of 65 years, and it is a common cause of hospitalization in younger adults. Moreover, the direct cost of HF care accounts for nearly 5% of total healthcare costs in America; two-thirds of this cost is attributable to HF hospitalization. However before HF patients require hospitalization, they are seen by clinicians in the general healthcare community (ie, the outpatient setting where most patients will receive the majority of their care). Although there have been many studies of the utilization of optimal care in the in-patient setting, there have not been any studies on the utilization of outpatient care.

Vascular load is an important determinant of ventricular function. This is particularly true of the failing heart, which is exquisitely load-sensitive. Vascular load comprises 2 major components: resistive load, which arises primarily at the arteriolar resistance vessels, and pulsatile load, which is primarily determined by aortic stiffness and early return of reflected waves from the periphery to the heart. Assessment of pulsatile load is gaining increasing prominence as evidence grows of a significant pathophysiologic role for arterial stiffness in cardiovascular disease, including heart failure. Assessment of arterial stiffness and vascular load is reviewed here. The importance of optimal ventricular-vascular coupling to maximize the efficiency of cardiac ejection is discussed. Current knowledge of arterial stiffness, vascular load, and ventricular-vascular coupling in systolic heart failure and in heart failure with a normal ejection fraction (“diastolic failure”) is described. Reducing aortic stiffness may form an important future therapeutic target in patients with heart failure. (Congest Heart Fail. 2008;14:31-36) ©2008 Le Jacq

Heart failure is a geriatric syndrome. Over 80% of the heart failure patients are 65 years and older. With the “graying of America,” the incidence and prevalence of heart failure are projected to increase in the coming decades. Heart failure is also a cardiac syndrome. It is a mechanical and neurohormonal disorder of enormous complexity. As the end-stage condition for many other cardiovascular disorders, it is also the only cardiovascular disorder with increasing incidence and prevalence. Ironically, this is in part due to the fact of better treatment of hypertension and coronary artery disease, and the aging of the population. Heart failure is also a health services syndrome. With about one million hospitalizations annually, heart failure is the number one reason for hospital admissions in the United States and one of the most expensive diseases for the Center for Medicare and Medicaid Services. Assessment of heart failure may be difficult, and its management is complex and rapidly evolving. Assessment and management of heart failure may be challenging for busy generalist clinicians. The assessment and management are simplified by a five step approach.

As the population ages, hospitalists and emergency department physicians can anticipate caring for an increasing number of patients with heart failure (HF). HF is a progressive disease, so the number of cases of acute decompensated heart failure (ADHF) can be expected to rise as well. The paradigm of care for these patients is changing. While the current state of knowledge about the pathophysiology that underlies HF and ADHF is good, as with all aspects of cardiology, continued research may provide additional insight leading to new treatment strategies using available agents as well as the development of new agents. Physicians who care for ADHF patients need to stay current on the efficacy, safety, and tolerability of all medications used to treat ADHF to optimize care of these patients.

The Preventive Cardiovascular Nurses Association offers complimentary online continuing educational programs. After taking this course participants will know the risk factors for heart failure, be able to conduct a physical patient assessment, and describe the invasive and noninvasive diagnostic tools used in assessing patients with hear failure.

The practice guidelines produced are intended to assist healthcare providers in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. These guidelines attempt to define practices that meet the needs of most patients in most circumstances. These guideline recommendations reflect a consensus of expert opinion after a thorough review of the available, current scientific evidence and are intended to improve patient care.

ACC/AHA Performance Measurement Sets are to be applied in either the inpatient and/or outpatient setting depending on the topic. Inpatient measures are usually, but not always, captured by retrospective data collection; outpatient reviews lend themselves to retrospective or prospective collection. These performance measures are designed to encourage the standardization of cardiovascular measurement.

The ACC and AHA aim to standardize the language used to describe cardiovascular diseases and procedures, enhance consistency in cardiology, and increase opportunities for sharing data across various data sources. The ultimate goal of ACC/AHA clinical data standards is to contribute to the infrastructure necessary for accomplishing the ACC/AHA’s mission of fostering optimal cardiovascular care and disease prevention.

Heart failure is a common condition among patients in nursing facilities and is one of the most common reasons for new or recurrent hospitalizations among persons over 65 years of age. Considerable progress has been made during the past decade in providing symptomatic relief for such patients. By implementing the processes and practices outlined in this guideline and by keeping up with new recommendations for managing heart failure as they emerge, the interdisciplinary care team can improve the quality of life of patients with heart failure in the nursing facility.

Heart failure (HF) is a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a complex therapeutic regimen. Knowledge about HF is accumulating so rapidly that individual clinicians may be unable to readily and adequately synthesize new information into effective strategies of care for patients with this syndrome. Trial data, though valuable, often do not give direction for individual patient management. These characteristics make heart failure an ideal candidate for practice guidelines.

The guideline is presented in an algorithmic format and is intended to provide a systematic approach to the pharmacologic management of patients with HF.

The aims of this position statement are to review (1) factors that affect exercise tolerance, with specific emphasis on chronic HF due to systolic dysfunction; (2) data that support the role of exercise training in chronic systolic HF, including the risks and benefits; (3) data on exercise training in patients with HF due to diastolic dysfunction; and finally (4) the subgroups of patients with HF for which data are lacking, and (5) the subgroups of patients who should not be included in exercise training programs. We anticipate this report will stimulate appropriate use of exercise training in patients with HF when indicated and encourage further studies in those areas in which data are lacking.

The package inserts for both rosiglitazone and pioglitazone indicate that patients with more advanced heart disease (class III or IV) were excluded in premarketing clinical trials, and hence, these drugs are not recommended in such patients. At present, there are no guidelines on the use of thiazolidinedione (TZD) in patients with diabetes who have any degree of heart disease or for those already on a TZD who develop CHF. Because edema is a more frequent side effect of TZD therapy and by itself is often a perplexing clinical dilemma with multiple causes, clinicians may need guidance when edema (or unexpected weight gain) is encountered in a patient on a TZD. For these reasons, the American Diabetes Association and the American Heart Association assembled a workgroup to evaluate the use of TZDs in patients with preexisting heart disease and in those who develop edema or unexpected weight gain during the course of TZD therapy. This Statement is a summary of the workgroup’s findings and recommendations.