PCNA’s December 2023 Cardio Connections Summit spotlighted heart failure and cardio-oncology content, including the latest guidelines and their application into clinical practice.

The faculty shared information and techniques on screening, severity prediction, and management of heart failure and cardiometabolic disorders, as well as strategies for selecting the right pacemaker for patients with heart failure. Cardio-oncology experts emphasized patient-centered care and the role of the cardiovascular nurse in this ever-growing field.

Presenters utilized case studies and research data to illustrate the latest guidelines for heart failure disease management and cardio-oncology care, including strategies to mitigate disparities experienced due to social determinants of health across populations.

Session recordings are available to view in our on-demand library at no charge.

• Heart Failure and Cardiometabolics: Back to the Basics, Predicted Severity, Prevention and Treatment Techniques
• Choosing the Right Cardiac Pacing Device: Heart Failure Interventions
• Cardio-Oncology: Patient-Centered Care across the Life Course
• Cardio-Oncology: The role of the nurse in the patient journey

Nursing Impacts on Heart Failure

The prevalence of heart failure continues to skyrocket in US adults. An estimated 8 million individuals will be affected by 2030.[1] Heart failure hospitalizes close to 1 million people each year—with nearly 1 in 4 patients facing readmission within 30 days of discharge.[2]  What can nurses do to help improve the quality of life of these patients and reduce the burden on individuals, families, and institutions?

Modifiable and non-modifiable risk factors for heart failure were the focus of presenter Kim Newlin, RN, CNS, ANP-C, a Nurse Practitioner with the Sutter Health Cardiovascular Service Line in Granite Bay, California. Kim described a new term, diabesity, that reflects the close relationship between cardiometabolic conditions, all of which impact the risk for heart failure.

Kim also shared about the burgeoning number of patients with cardiometabolic conditions. It is predicted that the number of U.S. adults with diabetes will increase six times over the next four decades. Along with being a risk factor for the development of cardiovascular disease (CVD), obesity is the number one risk factor for developing diabetes.[3] Kim also provided an overview of novel drug classes that may be used to treat diabetes and obesity and have proven outcome improvements in heart failure.

The American Heart Association has declared structural racism a cause of poor health and premature death from heart disease and stroke,[4] recognizing that a person’s race or ethnicity can increase a person’s chance of suffering a heart attack or stroke—or surviving it. While CVD rates, including heart failure and related cardiometabolic conditions, have been trending downward overall, social determinants of health continue to be evident in disparate health outcomes across race and ethnic minority populations.

The final portion of the presentation focused on the role of the cardiovascular nurse in heart failure treatment and emphasized the nurse as the cornerstone for care. The nurse plays an integral role across cardiovascular care and can significantly impact a wide range of issues, such as social determinants of health, access to care, patient education, implementation of clinical guidelines, and healthy lifestyle actions by patients. These actions impact individual patients and support overall system strategies to effect change and improve patient outcomes.

Paul Bibby, APRN, AGACNP-BC, Nurse Practitioner and Adjunct Faculty at Mayo Clinic Arizona in Phoenix, Arizona, discussed strategies for selecting the right pacemaker for patients with heart failure. Paul discussed available cardiac pacing devices and took a deep dive into common pacing modes in this patient population, their mechanism of action, and techniques for screening and assessment to select and manage cardiac resynchronization therapy (CRT).

CRT is a treatment for heart failure that can include heart rhythm pacing functions or pacing and defibrillation functions. CRT therapy is recommended in patients with heart failure and a left ventricular ejection fraction (LVEF) of <35%, presence of a left bundle branch block, QRS duration of >150 ms, and NYHA class II-IV symptoms on guideline-directed medical therapy for three months or more.

Cardio-oncology in Clinical Practice

As survivorship of cancer expands, many patients face an increased risk of cardiovascular disease as they age. Oncological drugs may have cardiotoxicity that impacts patients many years after their cancer treatments are complete. Identifying and addressing these risks before, during, and after cancer treatment is the focus of the relatively new field of cardio-oncology. Nurses are critical in the process of helping balance the need to optimize cancer outcomes along with minimizing the risk of cardiotoxicity.
Team-based strategies support patients with coordinated care for clinical, physical, and emotional needs.

Speaker Anecita Fadol, PhD, APRN, FAANP, FAAN, is a Nurse Practitioner and Associate Professor in the Department of Nursing with a joint appointment in the Department of Cardiology at the UT MD Anderson Cancer Center in Houston, Texas. Dr. Fadol described cardiovascular implications for oncology patients resulting from cardiotoxicity of anti-cancer treatments, as well as harm mitigation strategies in the face of these life-saving drugs. The session also included a discussion on the implications of increased survivorship of childhood and other cancers and the importance of team-based care in the cardio-oncology field.

Success with oncologic treatment has allowed cancer patients to experience longer cancer-free survival gains. Unfortunately, this success has been tempered by unintended—and often devastating—cardiac complications affecting overall patient outcomes.

The need for a focus on cardio-oncology continues to expand as cancer survivorship swells. The number of cancer survivors in the U.S. more than quadrupled from 3.6 million in 1975 to 15.5 million in 2016. Survivorship is predicted to reach over 20 million by 2026 and over 26 million by 2040, with most survivors in their 60s, 70s, and 80s.[5] Nearly two-thirds of survivors are currently 65 years of age or older, and many of these patients have concurrent cardiovascular disease.[6]

Dr. Fadol stressed that integrated team-based care for cancer patients today is paramount to preventing them from becoming cardiovascular disease patients of tomorrow.

Arnethea Sutton, PhD, Assistant Professor in the Department of Kinesiology and Health Sciences at Virginia Commonwealth University and a member of the VCU Massey Comprehensive Cancer Center, addressed the vital role of nursing in the cardio-oncology patient journey. Dr. Sutton exposed the growing inequities of outcomes for minority and under-resourced populations in both CVD and cancer, including shared testimony from patients undergoing cancer treatment.

Dr. Sutton defined cancer survivorship as the point from diagnosis through treatment and beyond. One of the strategies to prevent cardiotoxicities from anti-cancer treatment is the use of cardioprotective medication.  This breakthrough in cancer care, however, is not implemented equitably across gender and race.  Knowledge of these strategies and these gaps in care is imperative for cardiovascular healthcare providers in the continued quest for longer, healthier lives for cancer survivors.

You may find more detailed information about these topics by watching the recorded sessions on PCNA’s online learning system.

Look for PCNA’s next Cardio Connections Summit in late 2024.

PCNA is grateful to sponsors of the 2023 Cardio Connections Summit: Bristol Meyers Squibb-Pfizer Alliance, Merck Sharpe & Dohme Corp., and Abbott Laboratories. Thank you for showing your support for the role that nurses play in educating and managing these complex patient populations.

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[1] Virani SS, Alonso A, Aparicio HJ, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143:e254–e743. doi: 10.1161/CIR.0000000000000950

[2] Dharmarajan K, Hsieh AF, Lin Z., et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 23 January 2013;309(4):355-63. doi: 10.1001/jama.2012.216476

[3] Ng ACT, Delgado V, Borlaug BA, Bax JJ. Diabesity: The combined burden of obesity and diabetes on heart disease and the role of Imaging. Nature News. https://www.nature.com/articles/s41569-020-00465-5. Published November 13, 2020. Accessed January 20, 2023.

[4] Churchwell K, Elkind MSV, Benjamin RM, et al. Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory from the American Heart Association. Circulation. 2020;142:e452-e468. https://doi.org/10.1161/CIR.0000000000000936.

[5] Sanft T, et al. J Natl Compr Canc Netw. 2019;17(7):784-794. 2. Shapiro CL. N Engl J Med. 2018;379(25):2438-2450.

[6] National Institutes of Health. Office of Cancer Survivorship. Statistics. Accessed March 25, 2021.