Version June 2024
| Patient assessment |
| Evaluation |
| Medical history: Review current and prior cardiovascular medical and surgical diagnoses and procedures (including assessment of left ventricular function); comorbidities (including peripheral arterial disease, cerebral vascular disease, pulmonary disease, kidney disease, diabetes mellitus, musculoskeletal and neuromuscular disorders, depression, and other pertinent diseases); symptoms of cardiovascular disease; medications (including dose, frequency, and compliance); date of most recent influenza vaccination; cardiovascular risk profile; and educational barriers and preferences. Refer to each core component of care for relevant assessment measures. |
| Physical examination: Assess cardiopulmonary systems (including pulse rate and regularity, blood pressure, auscultation of heart and lungs, palpation and inspection of lower extremities for edema and presence of arterial pulses); post-cardiovascular procedure wound sites; orthopedic and neuromuscular status; and cognitive function. Refer to each core component for respective additional physical measures. |
| Testing: Obtain resting 12-lead ECG; assess patient's perceived health-related quality of life or health status. Refer to each core component for additional specified tests. |
| Interventions |
| Document the patient assessment information that reflects the patient's current status and guides the development and implementation of (1) a patient treatment plan that prioritizes goals and outlines intervention strategies for risk reduction, and (2) a discharge/follow-up plan that reflects progress toward goals and guides long-term secondary prevention plans. |
| Interactively, communicate the treatment and follow-up plans with the patient and appropriate family members/domestic partners in collaboration with the primary healthcare provider. |
| In concert with the primary care provider and/or cardiologist, ensure that the patient is taking appropriate doses of aspirin, clopidogrel, β -blockers, lipid-lowering agents, and ACE inhibitors or angiotensin receptor blockers as per the ACC/AHA, and that the patient has had an annual influenza vaccination. |
| Expected outcomes |
| Patient treatment plan: Documented evidence of patient assessment and priority short-term (ie, weeks-months) goals within the core components of care that guide intervention strategies. Discussion and provision of the initial and follow-up plans to the patient in collaboration with the primary healthcare provider. |
| Outcome report: Documented evidence of patient outcomes within the core components of care that reflects progress toward goals, including whether the patient is taking appropriate doses of aspirin, clopidogrel, β -blockers, and ACE inhibitors or angiotensin receptor blockers as per the ACC/AHA, and whether the patient has had an annual influenza vaccination (and if not, documented evidence for why not), and identifies specific areas that require further intervention and monitoring. |
| Discharge plan: Documented discharge plan summarizing long-term goals and strategies for success. |
| Nutritional counseling |
| Evaluation |
| Obtain estimates of total daily caloric intake and dietary content of saturated fat, trans fat, cholesterol, sodium, and nutrients. |
| Assess eating habits, including fruit and vegetable, whole grain, and fish consumption; number of meals and snacks; frequency of dining out; and alcohol consumption. |
| Determine target areas for nutrition intervention as outlined in the core components of weight, hypertension, diabetes, as well as heart failure, kidney disease, and other comorbidities. |
| Interventions |
| Prescribe specific dietary modifications aiming to at least attain the saturated fat and cholesterol content limits of the Therapeutic Lifestyle Change diet. Individualize diet plan according to specific target areas as outlined in the core components of weight, hypertension, and diabetes (as outlined in this table), as well as heart failure and other comorbidities. Recommendations should be sensitive and relevant to cultural preferences. |
| Educate and counsel patient (and appropriate family members/domestic partners) on dietary goals and how to attain them. |
| Incorporate behavior change models and compliance strategies into counseling sessions. |
| Expected outcomes |
| Patient adheres to prescribed diet. |
| Patient understands basic principles of dietary content, such as calories, fat, cholesterol, and nutrients. |
| A plan has been provided to address eating behavior problems. |
| Weight management |
| Evaluation |
| Measure weight, height, and waist circumference. Calculate body mass index (BMI). |
| Interventions |
| In patients with BMI >25 kg/m2 and/or waist >40 inches in men (102 cm) and >35 inches (88 cm) in women*: |
| • Establish reasonable short-term and long-term weight goals individualized to the patient and his or her associated risk factors (eg, reduce body weight by at least 5 percent and preferably by >10 percent at a rate of 1 to 2 lb/wk over a period of time up to sixmonths). |
| • Develop a combined diet, physical activity/exercise, and behavioral program designed to reduce total caloric intake, maintain appropriate intake of nutrients and fiber, and increase energy expenditure. The exercise component should strive to include daily, longer distance/duration walking (eg, 60 to 90 minutes). |
| • Aim for an energy deficit tailored to achieve weight goals (eg, 500 to 1000 kcal/day). |
| Expected outcomes |
| Short-term: Continue to assess and modify interventions until progressive weight loss is achieved. Provide referral to specialized, validated nutrition weight loss programs if weight goals are not achieved. |
| Long-term: Patient adheres to diet and physical activity/exercise program aimed toward attainment of established weight goal. |
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