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V-Aware: A Patient-Centric Vascular Education and Awareness Initiative
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JOURNAL OF VASCULAR NURSING www.jvascnurs.net
Abstract 13 V-Aware: A Patient-Centric Vascular Education and Awareness Initiative Deborah Hill, RN, Director of Research, Vascular Health Partners, Community Care Physicians, Albany, NY Objectives: Patients often have limited understanding of vascular risk factors, vascular health, and the various specialties that manage vascular disease. To better understand these gaps in patient awareness and education, we conducted a survey-based study among patients that have been diagnosed with vascular disease. Methods: A detailed vascular questionnaire designed to evaluate patient’s views on vascular health (PAD, Aneurysms, Stroke, Venous insufficiency) and vascular specialties (Vascular surgery, interventional cardiology, interventional radiology, cardiac surgery, and primary care) was used anonymously to survey 300 consecutive patients with a vascular diagnosis (44% Aneurysm, 56% PAD). Patient vascular education initiative (VEI) included a consultation, education of their risk factors, and treatment strategies as deemed appropriate by their vascular surgeons. The surveys were compiled to better understand the impact of vascular education on patient’s awareness of vascular disease and change in behavior. Results: Patient VEI had a substantial impact on patient’s understanding of vascular disease and its risk factors (pre-VEI 20%, post-VEI 89%, p<0.001), and specialty they considered best suited to manage their vascular health (Vascular surgery: PreVEI 26%, post-VEI 88%, p<0.001). Attributes most important to patients when choosing a vascular specialist included: specialist’s ability to communicate with the patient and their primary care physician (98%), reputation (94%), experience (95%), ability to perform endovascular procedures (92%), and the ability to be seen promptly (88%). Furthermore, 80% stated VEI changed their behavior towards personal vascular health, and 63% would share their experiences to help educate the public.
Abstract 14 Outcomes of a 3-Month Clinical PAD Rehabilitation Program Mary Whipple, BA, BSN, RN, University of Minnesota, Minneapolis, MN Given that there is currently no CMS reimbursement for supervised exercise programs for patients with peripheral artery disease (PAD), studies that document the effectiveness of structured exercise for PAD in a ‘‘real-world’’ setting are needed. Therefore, five Fairview Cardiac Rehabilitation sites, the University of Minnesota School of Nursing, and Vascular clinicians at both University of Minnesota and Fairview collaborated to evaluate clinical, functional, and quality of life outcomes following a 12-week clinical PAD-specific exercise program. We are the first program that we are aware of to offer a supervised exercise program for patients with PAD as part of clinical care. Method: Data will be collected from 40 patients with lifestyle-limiting claudication who enroll in the Wellness and Exer-
JUNE 2017
cise for Life program, an exercise program based in cardiac rehabilitation sites across the Fairview system. In addition to collection of demographic and medical history data, walking impairment, quality of life, and physical function are being measured at baseline and after completion of the 12-week program. Specific measures include the 6-minute walk test, Short Physical Performance Battery, Walking Impairment Questionnaire, Short Form - 36 and Peripheral Artery Disease Quality of Life questionnaire (PADQOL). Results: To date, 27 patients have completed 12-week data collection. The majority of patients were male (77%) and on average were 70.4 (9.3) years of age. Interim analyses suggest significant improvements from baseline to follow-up in peak walking distance (p=.022), and PADQOL in the ‘‘Symptoms and Limitations in Physical Functioning’’ (p=.027) and ‘‘Fear and Uncertainty’’ (p=.037) domains, as well as in sexual function and intimate relationships. Conclusions: The results of this study suggest that a clinicbased supervised exercise program is effective in improving peak walking distance and PADQOL among adults with PAD. This work provides evidence to support the need for CMS reimbursement of supervised, clinic-based PAD rehabilitation.
Abstract 15 A Prospective Randomized Study Comparing Groin Wound Complication with Negative Pressure Vacuum Assisted Dressing and Standard Gauzed Dressings: Interim Results Care Staley, MSN, RN-BC, AGACNP-BC, Thomas Jefferson University Hospital, Philadelphia, PA Megan McCullough, MSN, FNP, AGACNP, Thomas Jefferson University Hospital, Philadelphia, PA Post-operative groin infection is a high morbidity complication in vascular surgery. In this study, the negative pressure vacuum assisted dressing - PrevenaÔ (Kinetics Concept, Inc., San Antonio, TX) and standard dressing using gauze with TegadermÔ (3MÔ, St Pauls, MN) were used to compare wound complications in high risk patients undergoing elective vascular surgery. Methods This is a randomized prospective study of 94 in a single institution from January 2015 to May 2016. All patients undergoing a femoral incision during vascular reconstruction or repair were considered for the study, excluding emergency procedures. Patients were defined as high risk if they met one or more of the following: BMI > 30 kg/m2, reoperative surgery, placement of prosthetic graft, poor nutrition, immunosuppression, or diabetes with HbA1C > 8. High risk patients were randomized to the PrevenaÔ dressing or the standard dressing. The standard dressing was placed on all patients considered low risk (No risk factors). The Prevena dressing was removed 5 to 7 days postoperatively and incisions were assessed. Surgical incisions were evaluated 7 days and 30 days postoperatively. Results Eighty-Nine incisions were enrolled in the high risk group. Within the high risk group, 41 (46%) femoral incisions were in the PrevenaÔ arm and 36 (40%) incisions in the standard dressing arm. Twelve incisions
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
Abstract 13 V-Aware: A Patient-Centric Vascular Education and Awareness Initiative Deborah Hill, RN, Director of Research, Vascular Health Partners, Community Care Physicians, Albany, NY Objectives: Patients often have limited understanding of vascular risk factors, vascular health, and the various specialties that manage vascular disease. To better understand these gaps in patient awareness and education, we conducted a survey-based study among patients that have been diagnosed with vascular disease. Methods: A detailed vascular questionnaire designed to evaluate patient’s views on vascular health (PAD, Aneurysms, Stroke, Venous insufficiency) and vascular specialties (Vascular surgery, interventional cardiology, interventional radiology, cardiac surgery, and primary care) was used anonymously to survey 300 consecutive patients with a vascular diagnosis (44% Aneurysm, 56% PAD). Patient vascular education initiative (VEI) included a consultation, education of their risk factors, and treatment strategies as deemed appropriate by their vascular surgeons. The surveys were compiled to better understand the impact of vascular education on patient’s awareness of vascular disease and change in behavior. Results: Patient VEI had a substantial impact on patient’s understanding of vascular disease and its risk factors (pre-VEI 20%, post-VEI 89%, p<0.001), and specialty they considered best suited to manage their vascular health (Vascular surgery: PreVEI 26%, post-VEI 88%, p<0.001). Attributes most important to patients when choosing a vascular specialist included: specialist’s ability to communicate with the patient and their primary care physician (98%), reputation (94%), experience (95%), ability to perform endovascular procedures (92%), and the ability to be seen promptly (88%). Furthermore, 80% stated VEI changed their behavior towards personal vascular health, and 63% would share their experiences to help educate the public.
Abstract 14 Outcomes of a 3-Month Clinical PAD Rehabilitation Program Mary Whipple, BA, BSN, RN, University of Minnesota, Minneapolis, MN Given that there is currently no CMS reimbursement for supervised exercise programs for patients with peripheral artery disease (PAD), studies that document the effectiveness of structured exercise for PAD in a ‘‘real-world’’ setting are needed. Therefore, five Fairview Cardiac Rehabilitation sites, the University of Minnesota School of Nursing, and Vascular clinicians at both University of Minnesota and Fairview collaborated to evaluate clinical, functional, and quality of life outcomes following a 12-week clinical PAD-specific exercise program. We are the first program that we are aware of to offer a supervised exercise program for patients with PAD as part of clinical care. Method: Data will be collected from 40 patients with lifestyle-limiting claudication who enroll in the Wellness and Exer-
JUNE 2017
cise for Life program, an exercise program based in cardiac rehabilitation sites across the Fairview system. In addition to collection of demographic and medical history data, walking impairment, quality of life, and physical function are being measured at baseline and after completion of the 12-week program. Specific measures include the 6-minute walk test, Short Physical Performance Battery, Walking Impairment Questionnaire, Short Form - 36 and Peripheral Artery Disease Quality of Life questionnaire (PADQOL). Results: To date, 27 patients have completed 12-week data collection. The majority of patients were male (77%) and on average were 70.4 (9.3) years of age. Interim analyses suggest significant improvements from baseline to follow-up in peak walking distance (p=.022), and PADQOL in the ‘‘Symptoms and Limitations in Physical Functioning’’ (p=.027) and ‘‘Fear and Uncertainty’’ (p=.037) domains, as well as in sexual function and intimate relationships. Conclusions: The results of this study suggest that a clinicbased supervised exercise program is effective in improving peak walking distance and PADQOL among adults with PAD. This work provides evidence to support the need for CMS reimbursement of supervised, clinic-based PAD rehabilitation.
Abstract 15 A Prospective Randomized Study Comparing Groin Wound Complication with Negative Pressure Vacuum Assisted Dressing and Standard Gauzed Dressings: Interim Results Care Staley, MSN, RN-BC, AGACNP-BC, Thomas Jefferson University Hospital, Philadelphia, PA Megan McCullough, MSN, FNP, AGACNP, Thomas Jefferson University Hospital, Philadelphia, PA Post-operative groin infection is a high morbidity complication in vascular surgery. In this study, the negative pressure vacuum assisted dressing - PrevenaÔ (Kinetics Concept, Inc., San Antonio, TX) and standard dressing using gauze with TegadermÔ (3MÔ, St Pauls, MN) were used to compare wound complications in high risk patients undergoing elective vascular surgery. Methods This is a randomized prospective study of 94 in a single institution from January 2015 to May 2016. All patients undergoing a femoral incision during vascular reconstruction or repair were considered for the study, excluding emergency procedures. Patients were defined as high risk if they met one or more of the following: BMI > 30 kg/m2, reoperative surgery, placement of prosthetic graft, poor nutrition, immunosuppression, or diabetes with HbA1C > 8. High risk patients were randomized to the PrevenaÔ dressing or the standard dressing. The standard dressing was placed on all patients considered low risk (No risk factors). The Prevena dressing was removed 5 to 7 days postoperatively and incisions were assessed. Surgical incisions were evaluated 7 days and 30 days postoperatively. Results Eighty-Nine incisions were enrolled in the high risk group. Within the high risk group, 41 (46%) femoral incisions were in the PrevenaÔ arm and 36 (40%) incisions in the standard dressing arm. Twelve incisions