CARDIOVASCULAR DISEASE CARDIOVASCULAR DISEASE Cardiovascular Disease Introduction Cardiovascular disease posits a major cause of premature deaths and disability throughout the world and contributes to a significant increase in healthcare costs, particularly in medication, healthcare services, and production loss. Specifically, heart diseases and stroke accommodate the highest prevalence rate in the USA; accommodate an average of 610,000 and 365,000 annual deaths from CVD (CDC, 2015). Similarly, every year, CVD causes the USA approximately, $207 billion for medication, healthcare services, and productivity loss. Noteworthy, heart diseases and stroke incidences vary with factors such as ethnicity, gender, age, and individuals with certain disorders. Similarly, the project accommodates notable articulations on intervention, comparison, outcome, and time as a fundamental consideration in heart diseases and stroke in the USA. Thus, an enriched articulation on heart diseases and stroke are underscoring for the project presentation. Definition According to (Mayo Clinic, 2018), Heart disease describes a condition that affects the heart; including blood vessels diseases arrhythmias, and other heart defects. Significantly, the heart disease is interchangeable for the CVD, articulating on the infections involving narrowed or blocked blood vessels, causing a heart attack, chest pain, and stroke, among other clinical presentations. Similarly, (Mayo Clinic, 2018) acknowledges that many CVD is preventable and treatable with healthy lifestyle choices. Epidemiology Cardiovascular diseases posits an undying cause of death in the USA, projected at 840, 678 deaths in 2016, averagely one in three deaths (Salim et al. 2020). Similarly, between 2013 and 2016 121.5 million adults Americans presented notable for of the CVD. Notably, between 2013 and 2015 direct and indirect costs of managing the CVD in the USA, recorded $213.8 billion and $137.4 billion respectively. Statistically, between 2013 and 2016, 57.1% of non-HN black females and 60.1% of non-HN black males presenting CVD manifestations (Salim et al. 2020). According to the researcher causes of the CVD Include atherosclerosis resulting from an unhealthy diet, lacking exercise, overweight, and smoking. In the epistemology studies, risk factors such as age, sex, family history, smoking, chemotherapy and radiation drugs, high blood pressure, poor diet, obesity, physical inactivity, stress, and poor hygiene are underscoring risk factors in the CVD (Mayo Clinic, 2018). Thus, heart disease epistemological indicates the patterns, causes, risk factors, and specific populations in the USA. Clinical Presentations Cardiovascular disease acclaims clinical presentations that may differ between men and women. According to (Mayo Clinic, 2018), men present significant chest pain that women and women clinical presentations such as shortness in breathing, nausea, and fatigue are more evident than in men. Admi ...

1. CARDIOVASCULAR DISEASE
CARDIOVASCULAR DISEASE
Cardiovascular Disease
Introduction
Cardiovascular disease posits a major cause of premature deaths
and disability throughout the world and contributes to a
significant increase in healthcare costs, particularly in
medication, healthcare services, and production loss.
Specifically, heart diseases and stroke accommodate the highest
prevalence rate in the USA; accommodate an average of
610,000 and 365,000 annual deaths from CVD (CDC, 2015).
Similarly, every year, CVD causes the USA approximately,
$207 billion for medication, healthcare services, and
productivity loss. Noteworthy, heart diseases and stroke
incidences vary with factors such as ethnicity, gender, age, and
individuals with certain disorders. Similarly, the project
accommodates notable articulations on intervention,

2. comparison, outcome, and time as a fundamental consideration
in heart diseases and stroke in the USA. Thus, an enriched
articulation on heart diseases and stroke are underscoring for
the project presentation.
Definition
According to (Mayo Clinic, 2018), Heart disease describes a
condition that affects the heart; including blood vessels diseases
arrhythmias, and other heart defects. Significantly, the heart
disease is interchangeable for the CVD, articulating on the
infections involving narrowed or blocked blood vessels, causing
a heart attack, chest pain, and stroke, among other clinical
presentations. Similarly, (Mayo Clinic, 2018) acknowledges that
many CVD is preventable and treatable with healthy lifestyle
choices.
Epidemiology
Cardiovascular diseases posits an undying cause of death in the
USA, projected at 840, 678 deaths in 2016, averagely one in
three deaths (Salim et al. 2020). Similarly, between 2013 and
2016 121.5 million adults Americans presented notable for of
the CVD. Notably, between 2013 and 2015 direct and indirect
costs of managing the CVD in the USA, recorded $213.8 billion
and $137.4 billion respectively. Statistically, between 2013 and
2016, 57.1% of non-HN black females and 60.1% of non-HN
black males presenting CVD manifestations (Salim et al. 2020).
According to the researcher causes of the CVD Include
atherosclerosis resulting from an unhealthy diet, lacking
exercise, overweight, and smoking. In the epistemology studies,
risk factors such as age, sex, family history, smoking,
chemotherapy and radiation drugs, high blood pressure, poor
diet, obesity, physical inactivity, stress, and poor hygiene are
underscoring risk factors in the CVD (Mayo Clinic, 2018).
Thus, heart disease epistemological indicates the patterns,
causes, risk factors, and specific populations in the USA.
Clinical Presentations
Cardiovascular disease acclaims clinical presentations that may
differ between men and women. According to (Mayo Clinic,

3. 2018), men present significant chest pain that women and
women clinical presentations such as shortness in breathing,
nausea, and fatigue are more evident than in men. Admittedly,
the general clinical presentation of the CVD includes chest pet,
and discomfort, , tightness pressure ,pain, numbness, and
weakness, and pain regions such as neck, jaw, upper abdomen,
back, and throat (Mayo Clinic, 2018). Thus, prominent
manifestations such as chest pain, shortness of breath, and
fainting prompt a patient to see a doctor for diagnosis and
clinical management.
Complications
The CVD complication results from heart arrhythmias, and
dilated cardiomyopathy and, heart defects, heart infections and,
atherosclerotic diseases. According to (Mayo Clinic, 2018),
heart disease and stroke complications include heart failure,
heart attack, stroke, peripheral artery diseases, cardiac arrest,
and aneurysm. Therefore, a comprehensive diagnosis should
accommodate heart disease complications for evidence-based
case management.
Diagnosis
Heart diseases acclaim several diagnosis methods and
procedures in clinical settings for effective case identification
and management among patients. Some diagnoses and stress
include X-ray, ECG, exercise stress test, echocardiography,
blood test, coronary angiography, MRI scan, CT scans, and
radionuclide test (Salim et al. 2020). Thus, identifying
appropriate diagnosis methods in clinical testing is necessary
for an effective outcome and heart disease management.
Conclusion with PICOT Question
In conclusion, understanding the definition of epidemiological
studies, clinical presentations, complication, diagnosis, and
PICOT question provide an enriched articulation on heart
disease and stroke management in the USA. (P) In the patient
with risk factors for CVD (I), how does exposure behavior such
as smoking and physical inactivity (C) versus a patient with
limited and unknown risk factors (I) contribute to CVD

4. treatment (T) in two years’ time frame?
References
Centers for Diseases Control and Prevention. (2015). Heart
Disease Facts. https://www.cdc.gov/heartdisease/facts.htm
Mayo Clinic. (2018). Heart Disease.
https://www.mayoclinic.org/diseases-conditions/heart-
disease/symptoms-causes/syc-20353118
Salim, V. et al. (2020). Heart Disease and Stroke Statistics—
2020 Update: A Report from the American Heart Association.
AHA Journals, 141, 9.
https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000
000757
Evidence Table Worksheet
Student’s name
Instructor
Course
Date

5. I. PICOT Question: (P) In patients with risk factors for CAD (I)
how does exposure to extreme life stressors (C) vs patients with
no known risk factors (I) contribute to the development of an
acute STEMI/NSTEMI (T) in a 1-year time frame.
Running head: Evidence Table Worksheet
1
Evidence Table Worksheet
2
1.
Will you have a comparison group or will subjects be their own
controls?
I will make my derivations dependent on the comparison group I
picked concerning the statistical meaning of the study results
procured.
2. Is a ‘time’ appropriate with your question—why or why not?

6. Yes, for the reason that CAD patient require ample time when
educated them about nursing interventions in order to record
gradual change in risk factors.
II. Evidence Synthesis
(database) ex: Cochran
Study #1
Study #2
Study #3
Study #4
Study #5
Synthesis
(p) Population
Men and women between 25-60 years.
Included CAD participants were from all gender and age.
CAD participants from all age and gender.
90 CAD patients averaged 59.3 years.
Adults above or equal to 64 years.
Involved CAD participant from all ages and gender.
(I) Intervention
Teaching CAD patients about healthy living lifestyles.
Modifying CAD risk factors.
Fractional flow reserve – guided strategy
Flexible health program
Nutritious eating plan
Maintaining the selected lifestyle with healthy activities
(c) Comparison
Patients with no risk factors didn’t receive teachings on
modifiable risk factors.
Improper risk factors modification
No use of educational programs

7. Mediations were not used to patients with no known risk
factors.
Living unhealthy lifestyle.
Inactive and unhealthy lifestyle.
(o) Outcome
Estimated 24% decrease of risk for patients to develop CAD
CAD patients supported by patient interventions reduced their
anxiety feeling, plus the progression of cardiovascular failure
reduces with smoking cessation while also maintaining systolic
pulse.
The fractional flow reserve-guided strategy helped specialists to
monitor the health status of CAD patients.
participants who used mobile health mediations complied well
with medicines intake that significantly reduced coronary heart
disease progression.
The study showed DASH diets reduces the risk of developing
heart failure by 30%
Healthy lifestyle reduced the rate of CAD progression
(t) time
7 years
1 year
5 years
30 days
over 21.5 years
6.9
III. Evaluation Table
Citation
Design
Sample size: Adequate?
Major Variables:
Independent Dependent

8. Study findings: Strengths and weaknesses
Level of evidence
Evidence Synthesis
Fung et al. (2016)
Quantitative, a prospective analysis
6817, satisfactory
CAD prevalence was the dependent variable while lifestyle
modification was the independent variable.
Specialists have discovered CAD patients given healthy
teachings about modifiable risk factors is reducing. Satisfactory
research instrument was used to measure the quality. Study’s
limitation was lack of accessing confounding factors, for
instance utilization of medicines in management approaches,
patient’s functional status, and the severity of prevailing
concomitant
ailments.
Level I
The study’s results revealed that reducing CAD stressors
improved the quality of life of patients. for example,
researchers used an eating pattern as a modifiable appraisal
instrument that is set up on the premise that there are
inadequate appraisal tools that don’t require extensive time and
examination in the forecast of CAD risk. The analysis was
therefore projected to control the development of such
instrument by showing a dynamically compelling methodology
by which to separate CAD risk over dietary supervision.
Levy et al. (2018).
Analysis of literature using quantitative approach.
Unsuitable
Nutrition program was independent variable while CAD
prevalence was dependent variable.
Study shows that, CAD patients find it convincing and useful in
managing their conditions using phone services. An efficient
investigation and meta-survey of 27 novel researches was
included in the examination, and the findings revealed that

9. having no distinctions in death rates about the phone plus a
control population demonstrating a comparative dimension of
sufficiency. The phone provision mediations came with benefits
of reduce tension scores, lower systolic pulse, lower depression
scores, quitting smoking, and less admissions.
Level III
The study shows how psychological stressors affected CAD
patients exposing them to risk of future illnesses. When the
underlying issue become the episodes of heart failure, then it
becomes relentless to maintain patient care as an investment,
even in circumstances where patient have been diagnosed with
an uncommon cardiac arrest.
Lee et al. (2018).
Analysis of literature using quantitative approach
Inappropriate
The dependent variable was monitoring CAD patient’s status,
and the independent variable was fractional flow reserve-guided
strategy.
The wellbeing results of CAD patients can be easily analyzed
with the partial flow reserve-guided technique. Articles beyond
5 years were selected as a way of measuring the quality of this
study. The significant limitations are the execution of the faulty
real instrument for checking and data examination and moderate
headway of prominent obstructive physiology progresses
achieving prohibitions in the midst of the data gathering
process.
Level IV
The assessment was completed to make allowances concerning
the meaning of standard screening in patients with CAD to
screen their prosperity status and offer perfect interventions.
Giuliano et al. (2017)
Quantitative, a randomized controlled trial
90, quite adequate
Independent – medication reminders and education; Dependent
– health status in patients with CAD

10. This examination demonstrated that patients would by and large
show higher levels of exactness in their consistency element,
suggesting that texts could be a doable methodology for
enabling consistency with the dietary changes. The assessment's
primary quality is the use of ANOVA in light of the fact that the
example size is minimal. The restriction is that the data
gathering process required only 30 days, which isn't adequate to
consider each possible difference.
Level II
The overall self-revealed adherence didn't differentiate
altogether between social events that got medication refreshes
and educational works, educational text messages just or no
texts by any means. Thus, content illustrating and phone support
may be conceivably beneficial enhancements; notwithstanding,
they will likely not be fruitful all alone. Regardless, utilizing
the two methods may be considerably stronger than using either
procedure uninhibitedly.
Blaum et al. (2019)
Quantitative study, prospective analysis
4,490, adequate
Dependent- incidence of CAD; Independent dieting approach
Coronary disease recorded only a 21% diminishing in risk with
modifiable changes. The essential quality is using arranged data
gotten in the midst of the hour of over 21 years. The principal
impediment is the usage of just a single estimation tool to
perform information examination.
Level II
A successful reduction in various contributing factors to
cardiovascular failure may acquire an all the huger decline in
the risk of heart failure. Lifestyle modifications are critical
while alleviating CAD.
References
Blaum, C., Brunner, F. J., Kröger, F., Braetz, J., Lorenz, T.,
Goßling, A., ... & Waldeyer, C. (2019). Modifiable lifestyle risk

11. factors and C-reactive protein in patients with coronary artery
disease: Implications for an anti-inflammatory treatment target
population. European journal of preventive cardiology,
2047487319885458.
Fung, T. T., Pan, A., Hou, T., Mozaffarian, D., Rexrode, K. M.,
Willett, W. C., & Hu, F. B. (2016). Food quality score and the
risk of coronary artery disease: A prospective analysis in 3
cohorts. The American Journal of Clinical Nutrition, 104(1),
65–72. doi: 10.3945/ajcn.116.130393
Giuliano, C., Parmenter, B. J., Baker, M. K., Mitchell, B. L.,
Williams, A. D., Lyndon, K., ... & Levinger, I. (2017). Cardiac
rehabilitation for patients with coronary artery disease: a
practical guide to enhance patient outcomes through continuity
of care. Clinical Medicine Insights: Cardiology, 11,
1179546817710028.
Lee, J. M., Doh, J. H., Nam, C. W., Shin, E. S., & Koo, B. K.
(2018). Functional approach for coronary artery disease: Filling
the gap between evidence and practice. Korean Circulation
Journal, 48(3), 179-190. Doi: 10.4070/kcj.2017.0393
Levy, A. E., Huang, C., Huang, A., & Ho, P. M. (2018). Recent
approaches to improve medication adherence in patients with
coronary heart disease: Progress towards a learning healthcare
system. Current atherosclerosis reports, 20(1), 1-9.
My PICOT question is,
(P) In patients with risk factors for CAD (I) how does exposure
to extreme life stressors (C) vs patients with no known risk
factors (I) contribute to the development of an acute
STEMI/NSTEMI (T) in a 1-year time frame.
Stressful life events, such as natural calamities, financial crises,
terroristic attacks and wars, are known to be life-threatening

12. acute triggers for cardiac events, as are positive emotionally
charged events (sport matches and Christmas and New Year's
holidays), thus worsening the prognosis in vulnerable
individuals. Chronic stressors such as negative psychosocial
factors represent modifiable risk factors that could be linked to
adverse cardiac prognosis and the mortality rate worldwide. The
international INTERHEART case control study proved that
psychosocial factors were significantly related to acute
myocardial infarction, with an odds ratio. Further meta-analyses
of prospective observational studies found that certain
psychosocial factors, such as social isolation and loneliness,
were associated with a 50% increased risk of CVD; work-
related stress showed similar results, with a 40% risk of new
CV events. (Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F.,
Bianchi, M., Rovesti, M., & Roccia, M. G. 2018)
Reference
Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F., Bianchi, M.,
Rovesti, M., & Roccia, M. G.
(2018). Stress and Inflammation in Coronary Artery Disease: A
Review
Psychoneuroendocrineimmunology-Based. Frontiers in
immunology, 9, 2031.
https://doi.org/10.3389/fimmu.2018.02031