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Running head: PROFESSIONAL ACTION PLAN FOR ISCHEMIC HEART DISEASE
CONDITION
Professional Action Plan for Ischemic Heart Condition Disease
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PROFESSIONAL ACTION PLAN FOR ISCHEMIC HEART DISEASE CONDITION
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Professional Action Plan for Ischemic Heart Condition Disease
Introduction
Ischemic heart Disease also abbreviated as IBD refers to a condition in which the heart
muscles receive reduced supply of blood (Gibson, Shah & Umberger, 2014 359). Consequently,
IHD causes a discrepancy between the oxygen and supply and demand. IHD reflects a
manifestation of atherosclerosis of the coronary artery that can happen gradually or faster leading
to their blockage (Lilly, 2011). Ischemic heart disease has claimed and continues to be a major
cause of deaths in the industrialized nations such as America (Gibson, Shah & Umberger, 2014
359). The accumulation of cholesterol particles that are transported through blood in the arteries
lead to their corresponding accumulation on the arterial walls that innervate the heart (coronary
artery). These deposits may accumulate to levels that they form plaques that eventually narrow
the arteries causing reduced flow of blood (Lilly, 2011). Consequently, oxygen supply to the
heart muscles is reduced a great deal. It is noteworthy that ischemic heart disease is sometimes
referred to as coronary heart disease a term that is widely used in literature in place of the ICD
(Gibson, Shah & Umberger, 2014 359).
The signs and symptoms of ischemic heart disease conditions may show up either
gradually after or immediately the artery gets blocked. One of the most common symptoms of
IHD is angina pectoris or as it is famous angina which is a hallmark symptom of IHD (WHO,
2007). Angina is a medical term that is used to refer to significant pain and discomfort in the
chest due to decreased supply of oxygen to the heart (Lilly, 2011). Stable angina occurs when an
individual suffering from IHD exercises and comes through pain episodes that are predictable
and can be relieved by a deep and long rest (Gibson, Shah & Umberger, 2014 359). On the other
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hand, unstable angina occurs only at rest and occurs due to reduced response to treatments and is
unpredictable.
Variant angina is also another symptom that comes as pain caused by the spasms in the
coronary artery and is not predictable neither is it stress-induced (Bradshaw, Alfonso, Finn,
Owen & Thompson, 2009). The good thing with ischemic heart disease, is that it can be treated
through medications and alteration of lifestyles (National Heart Foundation of Australia, 2015).
This paper presents the issue of ischemic heart disease in the aboriginal population of Australia
and comes up with a professional action plan for the ischemic heart disease conditions on the
chosen Aboriginal population. Additionally, this paper also presents strategies that will be used
to fulfil the objectives and aims of the proposed professional action plan including their strengths
and drawbacks.
Population and Setting
The Noongar, Nyugar, Nyungah, Noonga or Nyoongar are indigenous Australian people
who inhabit the southern of Western Australia (Dana & Anderson, 2007, 514). The Noongar
country is occupied by 14 distinct groups that make part of the aboriginal population. These
people inhabit the Mediterranean climate lands and engage in different activities such as,
agriculture, hunting and gathering, to support their lifestyles (Dana & Anderson, 2007, 514).
With the setting of the contemporary Australian society, the Noongar people have had lost
generation and are currently faced with issues such as nutrition and diet among others that have
health, psychological and social importance (Dana & Anderson, 2007, 514). The indigenous
people in general and so the Noongar population, have been the center of research for most of the
chronic conditions both preventable and curable as well as non-curable chronic diseases (Dana &
Anderson, 2007, 514). Basing this action plan on the Noongar people will be beneficial and
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timely since it is the time when health issues of the indigenous people are being explored. Some
of the risk factors among the Noongpar people include smoking, obesity and diabetes that elevate
the levels of coronary heart disease (Dana & Anderson, 2007, 514).
Aim
The major aim of this professional action plan is to prevent, manage and rehabilitate
ischemic heart condition to meet the needs of the Noongar population of southern of WestAustralia.
Smart Objectives

To reduce the number of deaths, through preventing Ischemic heart disease conditions,
among the Noongar people by half the current rate in the next three years that is by 2019.

To effectively manage Ischemic heart disease prevalence and incidence among the
Noongpar people by 2018.

To rehabilitate the Noongar people who have Ischemic heart disease conditions by 2018.
Strategies
Secondary Ischemic Heart Disease Prevention Strategies
The first strategy under secondary prevention of CHD is education of the Patients on the
cardiovascular risk factors and their reduction strategies, importance of adhering to medication,
some self-monitoring skills, and lifestyle management elements that have an impact on prognosis
(National Heart Foundation of Australia, 2015). First off, the IHD patients must be educated on
how to increase their healthiness and promote individual wellness (Delgado, 2009). This can be
done through scheduled group meetings with the whole group of identified IHD patients. The
patients can also be taught the importance of adhering to medication and the impacts of not
observing that to their prognosis.
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The population should also be introduced to a comprehensive review that covers the
available options for the medication as well as the risk factors and the self-monitoring skills. The
population should also be taught on the symptoms of worsening CHD or IHD so that they are
able to take the right course of action (Delgado, 2009). The population should also be taught
about the need, appropriate levels and the best plans for physical activity (Boudi & Ahsan, 2015;
National Heart Foundation of Australia, 2015). In the education program, the whole population
from which the patients hail from can be accessed in order to promote awareness that will
prevent further increase in CHD among the population members. Some of the outcome measures
is the decreased rate of mortality and comorbidity among the population.
The whole population should also be educated on the risk factor modification options that
are available (National Heart Foundation of Australia, 2015). This will majorly cover the
lifestyle changing options among the Noongar population. First off, they will be taken through
the methods and benefits used in control of weight and maintenance of a good body-mass index
(BMI). In this case, the recommended BMI will be 18.5-24.9 kg/m2 (Boudi & Ahsan, 2015).
Additionally, the population should also be taught on how to maintain a waist circumference of
30 inches for the females and 40 inches for men (National Heart Foundation of Australia, 2015).
The other important education that the Noongar people will be taken through is lipid
management methods, how to control their blood pressure, and the importance of ceasing
smoking and alcohol (National Heart Foundation of Australia, 2015). Additionally, for the
patients diagnosed with diabetes mellitus after screening will be taken through an individualized
medical, dietary, and lifestyle management education.
Risk Factor Modification
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Encouraging the patients to adopt healthy eating lifestyles through inclusion of plant
based meals and foods in their diet (National Heart Foundation of Australia, 2015). The foods
include fruits, vegetables and whole grains. The patients and the whole population should be
encouraged to reduce consumption of high fat dairy products, unprocessed poultry, fish and meat
(Fihn et al., 2012). The population should also be encouraged to reduce salt intake and avoid
saturated fatty acid and trans-fatty acid (Fihn et al., 2012).
The population after being evaluated for smoking should be encouraged to stop smoking
as well as avoid secondary smoke from smokers (Fihn et al., 2012). The smokers can be given
smoking cessation therapy or enrolled in smoking cessation program as well as pharmacotherapy
for the patients who still smoke (Qaseem, 2012). The population that smokes will be introduced
to the stepwise smoking cessation strategy that involves asking, advising, assessing, assisting and
arranging (Boudi & Ahsan, 2015). The next phase would be mandatory and scheduled strict
follow-up (National Heart Foundation of Australia, 2015; WHO, 2007). For weight loss the
patients and the whole population in general will be advised on how to observe their caloric
intake, conduct structured 150 minutes exercises per week and general behavioural programs and
practices that will reduce keep check of BMI and weight (Boudi & Ahsan, 2015).
The population and the patients will be taken through some basic exercises (Qaseem,
2012). However, initially there must be a mandatory exercise test to asses and therefore group
the patients and the other population that is not suffering (National Heart Foundation of
Australia, 2015). The patients should be encouraged to walk at least five days a week and have
physical exercises of about 30 minutes such as jogging, walking, hitting the gym, gardening and
doing household chores (National Heart Foundation of Australia, 2015; WHO, 2007). There will
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also be the inclusion of home-based programs for the high-risk patients drawn from the
population.
Ischemic Heart Disease Management Strategies
There are two major management strategies for IHD that is medical and pharmacological
management. Medical management involves various therapies that target and thus reduce lipids
such as satin. The satin therapy should be started for the Noongar patients who have been
hospitalized after the assessment and diagnosis phases (Boudi & Ahsan, 2015). The patients
should be made to understand the benefit of satin as a medical intervention that will enrich their
lives (National Heart Foundation of Australia, 2015). Moreover, the patients should be
emancipated about the importance of engaging in lifestyle changes despite taking satin doses.
For the overweight patients they should be given Fibrates to reduce their cardiovascular risks
especially when diagnosed with type 2 diabetes (Fihn et al., 2012; Qaseem, 2012). Ezetimibe
can also be administered to the patients to reduce the concentration levels of LDL-C either
independently or alongside satin therapy (Boudi & Ahsan, 2015).
The patients diagnosed with hypotension should be advised on the need for managing
their weight, avoiding alcohol and high salt intake (Boudi & Ahsan, 2015). In adverse cases of
hypotension then combination of drugs can be used to manage the situation (Lavie & Milani,
2011). Vitamin C, E and beta carotene supplements may also be administered to reduce the risks
among the IHD patients (Boudi & Ahsan, 2015). All the patients from the population that have
been diagnosed with IHD should receive jabs of influenza and pneumococcal vaccinations on an
annual basis unless there are contraindications (National Heart Foundation of Australia, 2015;
WHO, 2007).
Ischemic Heart Disease Rehabilitation strategies
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There are very many rehabilitation options or strategies that are available for IHD/CHD.
First step involves counselling the patients with comorbid depression using various channels
such as medical and peer counsellors (Lavie & Milani, 2011). This should be followed by a
depression medical management program. Patients with decreased adherence to medicine should
be encouraged to adhere to the medications for better health (Fihn et al., 2012). There should be
the inclusion of interpersonal psychotherapies and cognitive based behavioural therapies to
counter the effects of depression among the patients. Antidepressants such as serotonin reuptake
inhibitor can also be used (Leon, 2005).
The patients should also be given social support from the local specialists such as
physicians, social workers and cardiac rehabilitation organizations as well as psychologist when
diagnosed with depression (Lavie & Milani, 2011; Qaseem, 2012). Such organizations include
the Heart Support Australia and the Heart Foundation Walking Groups (Leon, 2005). Cardiac
rehabilitation strategies through education and exercises under the direction of physicians is also
beneficial for rehabilitation of IHD (Fihn et al., 2012; National Heart Foundation of Australia,
2015). The patients should be engaged in timed physical exercises, taken through the process of
understanding the need to change lifestyle, made to embrace chores that increase physical
activity and taught on the best diets to make them active and free from any heart conditions risk
factors (Lavie & Milani, 2011; Leon, 2005).
Actions, Outcome Measures, Outcome Indicators, by whom? And Timeline
Outcome Measures

Registers of inpatients and outpatients of Noongar suffering from IHD in West Australian
Hospitals.
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PROFESSIONAL ACTION PLAN FOR ISCHEMIC HEART DISEASE CONDITION
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Surveys on the number of people who have ceased smoking and are actively engaging in
exercises.

Attendance list of the education sessions among the Noongpar people.

Questionnaires and interviews on the quality of life and progress from the time of
intervention (Fihn et al., 2012).

Death registrar and reports on the Noongar who die from IHD.

Patient follow-ups.

Assessment of the frequency and adequacy of the intervention programs.

Surveillance of complications from IHD and associated disease.
Outcome Indicators

Long-term care

Mortality

Morbidity

Quality of life

Complications of IHD among infants

Premature death due to IHD

Emergency department visits

Hospitalizations

Invasive procedures (Fihn et al., 2012).
By Whom?
The intervention strategies are meant to be implemented by the General practitioners,
Nurses, Social workers, Cardiologists, radiology units, physician assistants, nutritionists and
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dieticians, and Advanced Practice Nurses (Fihn et al., 2012; National Heart Foundation of
Australia, 2015).
Strengths and Drawbacks

Prevention, management and rehabilitation of cardiovascular heart disease or IHD among
the Noongar people including the infants (Qaseem, 2012).

Restoration of the quality of life of the Noongar population through reducing the costs
associated with treatment of IHD (Qaseem, 2012).
Drawbacks

Costs associated with the whole action implementation process (Qaseem, 2012).

Some of the medications for cessation of smoking might worsen the situation further
leading to high suicide attempts due to varenicline (Qaseem, 2012).

False negative results of older and aged population due to high prevalence of IHD
(Qaseem, 2012).

The participation of the community is also not assured.
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Professional Action Plan
Aim: The major aim of this professional action plan is to prevent, manage and rehabilitate
ischemic heart condition to meet the needs of the Noongar population of southern of WestAustralia.
Objective
Strateg Actions
Outcomes
Outcome By who?
Timelin
y
Measures
Indicator
e
s
To reduce
Seconda Education
Surveillance of Long-term Nurses.
End of
the number
ry
Programs
the symptoms. care
Physicians. 2018
of deaths,
Preventi and
Hospitalization Mortality Advanced
through
on
Training
s.
Morbidity Practice
preventing
strategie sessions.
Patient follow- Quality of Nurses.
Ischemic
s for
Outreach
up.
life
Communit
heart disease Ischemi and
Registers of
Complicat y Based
conditions,
c Heart
Emancipatio inpatients and
ions of
Health
among the
Disease n programs. outpatients of
IHD
Organizati
Noongar
Conditio Smoke
Noongar
among
ons.
people by
ns.
Cessation
suffering from infants
Health
half the
programs.
IHD in West
Premature Institutions
current rate
Australian
death due and
in the next
Hospitals.
to IHD
Ministry of
three years
Surveys on the Emergenc Health.
that is by
number of
y
2019.
people who
departmen
have ceased
t visits
smoking and
Hospitaliz
are actively
ations
engaging in
Invasive
exercises.
procedure
Surveillance of s
complications
from IHD and
associated
disease.
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PROFESSIONAL ACTION PLAN FOR ISCHEMIC HEART DISEASE CONDITION
To
effectivel
y manage
Ischemic
heart
disease
prevalenc
e and
incidence
among
the
Noongpa
r people
by 2018.
Ischemi
c Heart
Disease
Manage
ment
Strategie
s.
Medical
Intervention
s.
Pharmacolo
gical
Intervention
s.
To
rehabilitate
the Noongar
people who
have
Ischemic
heart disease
conditions by
2018.
Ischemi
c Heart
Disease
Rehabili
tation
strategie
s
Psychologic
al
Managemen
t.
Cardiac
rehabilitatio
n.
Counselling
Medical
intervention
s
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Death registrar
and reports on
the Noongar
who die from
IHD.
Questionnaires
and interviews
on the quality
of life and
progress from
the time of
intervention.
Registers of
inpatients and
outpatients of
Noongar
suffering from
IHD in West
Australian
Hospitals
Surveillance of
complications
from IHD and
associated
disease.
Questionnaires
and interviews
on the quality
of life and
progress from
the time of
intervention.
Registers of
inpatients and
outpatients of
Noongar
suffering from
IHD in West
Australian
Hospitals.
Surveillance of
complications
from IHD and
associated
disease.
12
Quality of
life
Complicat
ions of
IHD
among
infants
Premature
death due
to IHD
Emergenc
y
departmen
t visits
Hospitaliz
ations
Invasive
procedure
s
Nurses.
Physicians.
Advanced
Practice
Nurses.
Communit
y Based
Health
Organizati
ons.
Health
Institutions
and
Ministry of
Health.
End of
2018
Quality of
life of the
Patients
Depressio
n levels
among the
Patients
Complicat
ions of
IHD
among
infants
Premature
death due
to IHD
Emergenc
y
departmen
t
readmissio
ns
Psychologi End of
sts.
2018
General
Practitioner
s.
APNs.
NGOs.
Social
Workers.
PROFESSIONAL ACTION PLAN FOR ISCHEMIC HEART DISEASE CONDITION
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Conclusion
This professional action plan is based on ischemic heart disease condition that is one of
the chronic diseases that affects different populations. The action plan proposes three strategies
that will be used in management, prevention and rehabilitation of patients with ischemic heart
disease conditions among the Noongar people of Western Australia. There are various
stakeholders that can use the information of this action plan. First off, the nurses and medical
practitioners can apply this action plan to mitigate the IHD among the Noongar people.
Secondly, the ministry of health can apply the action plan when coming up with policies and
funding various programs for the Noongar people. Lastly, the non-governmental organizations
can also use the action plan to respond to the challenges that are facing the Noongar with respect
to ischemic heart disease. Since Ischemic heart disease is widespread all over the world, this
action plan is adaptable to nearly all the populations in different countries.
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