Running Head: CARDIOVASCULAR DISEASES

CARDIOVASCULAR DISEASES IN UNDERSERVED

PATIENTS RESIDEING IN URBAN SETTINGS.

Christiana Ikome

PATHO PAPER (MODIFY COVER PAGE)

COPPIN STATE UNIVERSITY
HELENE FULD SCHOOL OF NURSING
FALL 2012

Running Head: CARDIOVASCULAR DISEASES

Cardiovascular diseases are a group of diseases including but not limited to coronary
artery disease (CAD) also called coronary heart disease, congestive heart failure (CHF), stroke or
cerebrovascular accident, peripheral arterial disease or peripheral vascular diseases, deep vein
thrombosis (DVT), rheumatic heart disease, congenital heart diseases and other
cardiomyopathies involving the valves, and lining of the heart.

Cardiac structural abnormalities

or changes, cardiac functional changes, hemodynamic changes, genetics, neuroheumoral and

inflammatory mechanisms have been implicated to cause or worsen cardiovascular diseases. For
the purpose of this assignment, the focus shall be on Coronary Artery Disease (CAD), and how it
affects underserved patients residing within urban settings. The rationale for selecting CAD is
because CAD is the most common type of heart disease and it is the leading cause of death in the
United States in both men and women (McCance 1160). The underserved patient residing in
characteristically identified areas with inadequate primary health care providers, inadequate
preventative care services, inadequate access to health care services due to low income, lack of
health insurance, and who have limited English language proficiency, those above age 65 years,
those lacking familiarity and knowledge with the health care delivery system suffer more from
cardiovascular diseases, obesity, alcoholism, poor nutrition etc, according to the Centers for
Disease Control and Prevention (CDC).
Coronary artery disease has been implicated as the leading cause of deaths in the United
States, affecting about 16 (sixteen) million Americans. According to McCance, although there
has been dramatic decline in mortality in the past decade, coronary artery disease causes about
one third of all deaths in the United States. An estimated number of deaths directly due to or
related to coronary artery disease is between 770.000 (seven hundred and seventy) thousand to 1
(one) million people each year (McCance 1160). Atherosclerosis is a dangerous progressive

Running Head: CARDIOVASCULAR DISEASES

pathologic process that can affect vascular systems throughout the body, and the heart in
particularly, where the vessels supplying blood to the heart are affected. It is for this reason that
important emphasis on education, prevention of risks factors is important as this process begins
earlier on in life. Risks factors are categorized as modifiable and non-modifiable. Risk factors
such as age, gender, family history etc, cannot be modified however, those risks factors which
contribute to arthrosclerosis, including but not limited to sedentary lifestyle, hypertension,
dyslipidemia, diabetes mellitus and insulin resistance, cigarette smoking, poor dietary choices,
and obesity can be modified and therefore measures to provide access to those in underserved
areas is imperative to avoid or reduce the incidence of heart disease in general, and coronary
heart disease in particular among patients residing in underserved areas.
Coronary artery diseases occur when the arteries that supply blood to the heart muscle
become hardened and narrowed. This is due to buildup of cholesterol and other material, known
as plaque, which accumulates in the inner walls of the coronary arteries. As the plague grows, the
patient is not aware, yet, damage to the heart and blood vessels persists as blood cannot smoothly
flow through the narrowed arteries. Consequently, the heart muscles cannot get the blood and or
oxygen it needs, leading to chest pain called angina, or heart attack. Over time, Coronary artery
Disease can also weaken the heart muscle and contribute to heart failure and arrhythmias.
Inadequate health care access, lack of insurance, lack of money, lack of education lack of
knowledge about healthcare system, and overall poor health characterizes people in areas
designated as underserved. Policy makers both in local and federal governments, as well as
private agencies have taken various measures to improve care among this group of patients,
although it is still a challenge. It is in this light that on March 21, 2010, congress passed into
law The Patient Protection and Affordable Care Act, which was signed by President Barack

Running Head: CARDIOVASCULAR DISEASES

Obama on March 23, 2010, which aims primarily to decrease the number of uninsured
Americans and reduce the overall cost of health care. The bill also provides a number of
mechanisms, including mandates, subsidies and tax credits to employers and individuals in order
to increase the insurance coverage rate. This bill will improve health care outcomes and
streamlining the delivery of health care services and shall cover all applicants, regardless of
preexisting conditions such as diabetes, heart disease, cancer etc.
In an effort to control or take measures to alleviate the incidence of cardiovascular
disease in general and coronary artery disease in particular, especially among underserved
population, agencies such as WISEWOMEN, through the Centers for disease control and
prevention (CDC), has taken initiatives to administer through CDCs division of heart disease
and stroke prevention, screenings, lifestyle interventions, referral, counseling and teaching right
dietary practices and emphasize on lifestyle modification to underserved, low-income, underinsured or uninsured women, with chronic disease risk as a goal to prevent cardiovascular
diseases. The CDC funds more than twenty one WISEWOMAN programs, which operate at
local level within states and tribal organizations. These programs provide opportunities for local,
uneducated, uninsured women to have access to primary care treatment and screening.
The Alabama state and local government for instance, has set up programs to train health
care workers to reduce health disparities in Alabama inner cities, by way of creating
organizations such as the Pine Apple Heart Disease and Stroke Project. The project was
conducted in Wilcox county, a South-Centered Alabama black belt county, where there seems to
be extreme poverty and woefully inadequate health care (Kuhajda, 2006). Programs such as this
helps reduces the health care disparity between white women and African American women, who

Running Head: CARDIOVASCULAR DISEASES

have a significantly high mortality rate from heart disease and stroke than white women, despite
advices in treatment and management of risk factor.
Lack of access to health care can keep people from leaning how to self manage a chronic
disease and how to appropriately use medical care to achieve good health. It is in this light that
institutions such as Mount Carmel health care in Columbus OH, a nonprofit organization, has
taken initiatives to set in place ways for the underserved, uninsured needy populations to receive
treatment and education by way of creating and organizing local health care clinics in
community halls, local churches, and even in designated peoples houses, so that physicians can
be assessable, and education on self-care, diet, exercise and other lifestyle modifications
strategies can be brought to these underserved population. The overall goal for such community
outreach is to eliminate health disparities within minority populations, provide education and
improve access to care as well as providing holistic care.
A study in 2007 by Sampselle C. reveals that despite all efforts to alleviate heart diseases,
African Americans, especially women, are still vulnerable to heart disease and stroke due to lack
of economic stability, insufficient availability of health care resources, knowledge deficit about
disease process, and ethnic beliefs regarding health, wellness, and sickness. The study further
reveals that minority women are at risk because of environmental stress and poor nutrition. Low
income was also highlighted as one of the barriers to have access to health care. The study
showed that on average, men earn more than women. In comparison to 41 % of male workforce,
59% of women work in jobs that pay below the US official poverty level (Sampselle 2007).
Another study conducted in 2006 by Thompson S. reveals that heart diseases and stroke
prevention are not among the popular health promotion activities offered by employers. Popular
health promotion activities offered by employers are in the areas of nutrition, tobacco, alcohol

Running Head: CARDIOVASCULAR DISEASES

and other drugs, mental health and mental disorders. The study further reveals that health
promotion at work sites have been exclusively offered in white collar work sites with white
collar workers, and not in areas characterized as underserved.
Most of the literature reviewed reveal that over the past decade, women tend to have
higher mortality and morbidity from cardiovascular diseases compared to men because according
to Pearson 2010, women have a greater number of comorbidities present at the time of an event
or the older age of women when they are diagnosed with cardiovascular diseases. Another factor
noted in the review of literature is that women are less likely to receive aggressive medical or
invasive treatment for heart disease compared to men. There is also often a failure by both the
healthcare providers and women themselves, to recognize either the underlying risks or the
associated symptoms of cardiovascular diseases because of the uncharacteristic presentation of
symptoms in women. Analysis of literature further reveals that underserved population is at a
uniquely increased risk because of the prevalence of hypertension, obesity and diabetes (Pearson
2010). All these issues contribute to the poor outcome of cardiovascular diseases seen in
underserved populations.
While the scope of practice for nurse practitioners varies from state to state, nurse
practitioners are health care professionals with the capacity to provide not only education to the
underserved population about cardiovascular diseases, but the nurse practitioner has a unique
role as a primary health care provider, who has a responsibility of not only assisting the patient to
improve lifestyle, but to provide access to or facilitate access to primary health care services.
The nurse practitioner has an obligation to provide high quality, yet affordable patient-centered
care in order to improve the lives of those they serve. With the recent passage of The Patient

Running Head: CARDIOVASCULAR DISEASES

Protection and Affordable Care Act, the nurse practitioners role shall expand to meet the
current and growing demand for primary care.

Running Head: CARDIOVASCULAR DISEASES

References
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Tennessee: a descriptive study. Journal Of The American Academy Of Nurse
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underestimated. Family & Community Health, 30(1S), S4-14.
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