June 15, 1999
A Johns Hopkins study of women who had coronary bypass surgery found that a year later, a majority of them continued to have the same significant risk factors that brought them to the operating room in the first place.
Lulled perhaps by a false sense of security or lacking good risk factor information, "women showed substantial risk factors a year after their surgery, making them vulnerable to further heart disease," according to Jerilyn Allen, Sc.D., R.N., a nurse researcher and associate professor at The Johns Hopkins University School of Nursing.
In the study of 130 women between the ages of 55 and 75 with heart disease, published in the June issue of the Journal of Women's Health and Gender-Based Medicine, Allen found that a year after bypass, 58 percent were obese, 54 percent had high blood pressure and 92 percent had high cholesterol levels. Before surgery, 17 percent of the women in the study smoked cigarettes; a year later, 10 percent still smoked. And although patients reported consuming less fat, saturated fat and dietary cholesterol, amounts remained above recommended levels.
"The study indicates that heart disease risk factors are not being adequately managed," says Allen. "And because coronary heart disease is by far the leading cause of death among women, it is critical that these factors be reduced. Some cardiac patients may view themselves as fixed' after bypass surgery. Other patients are not being properly informed about the risk factors that lead to secondary episodes of heart disease. Patients do not spontaneously modify their risk factors after bypass surgery, so health care providers at all levels need to inform patients about their risk for subsequent disease."
Allen also is studying the effectiveness of a nurse intervention model as a way to manage risk factors in cardiac patients. "Nurses know how to help patients make difficult lifestyle changes and manage risk factors," she says. "Nurse case managers could be hired as part of group practices to ensure risk factor modification. Cardiologists, primary care physicians and nurse practitioners need to play a key role in preventing future cardiac problems in patients."
Allen says health care providers should encourage patients with coronary disease to stop smoking, modify certain lifestyle behaviors such as weight control, follow a low-fat diet and increase physical activity. Patients also need to be more active in managing their own care.
"In addition to making some basic lifestyle changes, such as initiating a low-fat diet to reduce cholesterol, patients must know their numbers," says Allen. "Know what your cholesterol level is, know your blood pressure. If your providers aren't testing you for these things, ask them."