NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan

Preliminary Care Coordination Plan

The care coordination plan emerged in response to the growing recognition of the significant prevalence and costs associated with chronic illnesses among patients. It developed due to the shortcomings and fragmentation in a healthcare system primarily focused on fee-for-service and acute care. An interdisciplinary team is crucial for developing a comprehensive care plan for addressing heart disease.

This plan (NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan) should emphasize continuous communication and monitoring to assess its effectiveness in meeting the patient’s needs. The main objective of this assessment is to examine heart disease as a health issue, establish Smart goals, and identify community resources for coordinating care effectively.

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Examining Heart Disease and Associated Best Practices

Heart disease also known as cardiovascular disease, is a prevalent chronic health condition globally, and encompasses a range of cardiac disorders such as coronary artery disease, arrhythmias, and heart failure. Its impact is profound, leading to significant morbidity and mortality rates worldwide. Heart disease is a leading cause of various health complications, including hypertension, stroke, and kidney disease, rendering it a critical public health issue on a global scale. Prevalence rates of heart disease vary among regions and nations, with disparities often observed, particularly in less developed countries.

According to the World Health Organization (WHO), Cardiovascular Diseases (CVDs) represent the primary cause of mortality worldwide, claiming an estimated 17.9 million lives annually. These diseases encompass a spectrum of disorders affecting the heart and blood vessels, including coronary heart disease, cerebrovascular disease, and rheumatic heart disease. Notably, the majority of CVD-related deaths stem from heart attacks and strokes, with a significant portion occurring prematurely among individuals under 70 years old (World Health Organization, 2023). 

The Centers for Disease Control and Prevention (CDC) presents a snapshot of the impact of Coronary Heart Disease (CHD) in the United States (Centers for Disease Control and Prevention, 2020). With 4.9% of adults diagnosed, 13.0 million physician office visits, and CHD indicators in 6.9% of office visits and 6.4% of emergency department visits, the prevalence of CHD is evident in healthcare settings. However, the stark reality lies in the 695,547 deaths attributed to CHD, making it the leading cause of mortality (Centers for Disease Control and Prevention, 2020). 

Heart disease is caused by several factors. WHO emphasized that several behavioral risk factors significantly contribute to the development of heart disease and stroke. These include unhealthy dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption (World Health Organization, 2023). These behaviors often manifest in individuals as elevated blood pressure, blood glucose, blood lipids, overweight, and obesity, all of which heighten the risk of heart attack, stroke, and other complications. Other factors contributing to heart disease include genetic predisposition, stress, and underlying medical conditions. Often asymptomatic in its early stages, heart disease presents challenges in early detection and management. However, as the disease progresses, patients can experience symptoms such as chest pain, shortness of breath, and fatigue.

 Healthcare providers play a critical role in prioritizing heart disease screening and management in their practice, while patients can actively engage in their health by adopting healthy habits and adhering to treatment plans (Gooding et al., 2020). With a comprehensive approach encompassing prevention, detection, and management strategies, it is possible to mitigate the prevalence and burden of heart disease, thus enhancing health outcomes for individuals and populations.

Best Practices for Improvement

Heart disease presents a significant healthcare challenge, contributing to complications such as heart attacks, strokes, and kidney failure (Gooding et al., 2020). However, its impact (NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan) can be mitigated through the implementation of evidence-based best practices. Lifestyle modification emerges as a cornerstone in heart disease management, encompassing maintaining a healthy weight, regular physical activity, limiting alcohol consumption, reducing salt intake, and adopting a balanced diet rich in fruits, vegetables, and whole grains. Moreover, smoking cessation is imperative for decreasing the risk of heart disease-related complications.

Pharmacological interventions are also crucial in managing heart disease, with antihypertensive medications proving effective in reducing blood pressure levels (Upadhya & Kitzman, 2020). Treatment plans should be specified to each patient, considering their medical history, comorbidities, and risk factors.

Furthermore, patient education and self-management are essential components of heart disease management. Empowering patients with knowledge about their condition, the importance of medication adherence, regular monitoring of cardiac health, and scheduled follow-up visits with healthcare providers are paramount. Additionally, telemedicine emerges as a valuable tool in remotely monitoring cardiac health, reducing the need for frequent office visits for uncomplicated cases. This approach not only alleviates the burden on healthcare systems but also enhances patient satisfaction. By embracing these practices, healthcare professionals can prevent complications associated with heart disease and enhance the overall quality of life for affected individuals.

Underlying Assumptions and Points of Uncertainty – NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan

Underlying assumptions for heart disease often revolve around lifestyle factors, such as poor dietary choices and sedentary habits, as primary contributors to its development (Barbu et al., 2021). While these factors indeed play a significant role, it’s important to recognize the influence of genetic predispositions and environmental factors in the onset of heart disease. Additionally, there’s a common misconception that medication alone is the primary treatment for heart disease. However, lifestyle modifications, including dietary adjustments and regular exercise, can also prove effective in managing cardiac health and reducing the risk of complications.

Another prevalent assumption is that heart disease is an inevitable consequence of aging (Madsen et al., 2020). While age can be a contributing factor, proactive management strategies can significantly mitigate its impact and prevent further health complications. Moreover, it’s essential to acknowledge the heterogeneity of heart disease; not all cases (NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan) are the same. Different types and causes of heart disease can necessitate different treatment approaches to address specific underlying factors and optimize outcomes.

Specific Goals to Address Heart Disease

It is very important to establish personalized and dynamic heart disease prevention goals that are not only realistic and measurable but also adaptable to evolving patient needs and circumstances. The analysis (Klaassen et al., 2023) revealed a mix of behavioral and health measure goals, with behavioral goals focusing on lifestyle changes like diet, physical activity, and smoking cessation, while health measure goals centered on objective markers such as weight, blood pressure, and lipid levels. These goals encompass behavioral and health measure objectives, ensuring a comprehensive approach to managing CVD risk factors.

To enhance heart health effectively, setting S.M.A.R.T. goals is key (Ullah et al., 2023). These goals should be Specific, Measurable, Achievable, Relevant, and Time-Specific. Specific goals (NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan) outline clear actions, measurable goals track progress, achievable goals build confidence, relevant goals align with your lifestyle, and time-specific goals provide accountability and momentum (Ullah et al., 2023). Setting SMART goals can greatly improve heart health:

Goal1: implementation of regular monitoring device 

  • Specific: Define objectives like eating oily fish thrice a week or walking for 30 minutes daily.
  • Measurability: Track progress to stay motivated and see results in real-time.
  • Achievable: To build momentum, start with manageable tasks, like a one-minute run.
  • Relevant: Tailor objectives to fit your lifestyle and circumstances.
  • Timeline: Establish deadlines for achieving goals to enhance motivation and accountability.

Through implementing this strategy, individuals can make manageable changes toward better cardiovascular health and sustain long-term success.

Identification of Community Resources

Community resources are essential for ensuring a safe and effective continuum of care for individuals with heart disease (Singh et al., 2022). Recovering from heart disease can be a lengthy process, and managing chronic conditions associated with it can pose ongoing challenges. Access to community resources is crucial in supporting patients throughout their recovery journey and helping them transition back to their normal daily lives. These resources provide invaluable support and assistance, empowering individuals with heart disease to navigate their condition effectively and improve their overall well-being. 

Creating a comprehensive continuum of care for heart disease involves utilizing various community resources. These include community health centers, cardiac rehabilitation programs, nutrition education initiatives, smoking cessation services, physical activity programs, support groups, telehealth services, and public health campaigns (Vidal-Almela et al., 2020). Credible evidence shows that these resources contribute to improved health outcomes by reducing cardiovascular risk factors, enhancing access to care, promoting healthy behaviors, and providing support for individuals with heart disease and their caregivers (Vidal-Almela et al., 2020). In integrating these resources effectively, communities can establish a safe and effective continuum of care for heart disease, ultimately improving community health.

American Heart Association (AHA) annually reports the most up-to-date statistics related to heart disease (Tsao et al., 2022). In identifying significant and available community resources for a safe and effective continuum of care, the statistical update is a valuable tool. It highlights the latest data on monitoring cardiovascular health in the population and emphasizes the importance of social determinants of health, adverse pregnancy outcomes, and vascular contributions to brain health.

By providing a comprehensive overview of the global burden of cardiovascular disease and healthy life expectancy, the statistical update offers critical insights for policymakers, healthcare professionals, researchers, and the general public (Tsao et al., 2022). It serves as a vital resource for guiding efforts to improve cardiovascular health and enhance the quality of care for individuals affected by heart disease and stroke.

Conclusion – NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan

Addressing heart disease requires a comprehensive approach that considers both individual and community-based interventions. As a result of implementing evidence-based best practices, setting specific and achievable goals, and leveraging available community resources, we can effectively manage heart disease, reduce its prevalence, and improve the overall health outcomes of affected individuals. Collaboration among healthcare professionals, policymakers, and community leaders is essential in establishing a safe and effective continuum of care for heart disease, ultimately enhancing community health and well-being.


NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Barbu, E., Popescu, M.-R., Popescu, A.-C., & Balanescu, S.-M. (2021). Phenotyping the prediabetic population—A closer look at intermediate glucose status and cardiovascular disease. International Journal of Molecular Sciences, 22(13), 6864.

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Centers for Disease Control and Prevention. (2020). Faststats – Heart disease. Centers for Disease Control and Prevention.

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Gooding, H. C., Gidding, S. S., Moran, A. E., Redmond, N., Allen, N. B., Bacha, F., Burns, T. L., Catov, J. M., Grandner, M. A., Harris, K. M., Johnson, H. M., Kiernan, M., Lewis, T. T., Matthews, K. A., Monaghan, M., Robinson, J. G., Tate, D., Bibbins‐Domingo, K., & Spring, B. (2020). Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group. Journal of the American Heart Association, 9(19).

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Klaassen, A. E., Kapanen, A. I., Zed, P. J., & Conklin, A. I. (2023). Setting goals to reduce cardiovascular risk: A retrospective chart review of a pharmacist-led initiative in the workplace. International Journal of Environmental Research and Public Health, 20(1), 846.

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Madsen, C. M., Varbo, A., & Nordestgaard, B. G. (2020). Novel Insights From Human Studies on the Role of High-Density Lipoprotein in Mortality and Noncardiovascular Disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 10.1161/ATVBAHA.120.314050(ATVBAHA.120.314050).

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Singh, G. K., Ivynian, S. E., Davidson, P. M., Ferguson, C., & Hickman, L. D. (2022). Elements of integrated palliative care in chronic heart failure across the care continuum: A scoping review. Heart, Lung and Circulation, 31(1), 32–41.

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Ferguson, J. F., Generoso, G., Ho, J. E., Kalani, R., Khan, S. S., Kissela, B. M., & Knutson, K. L. (2022). Heart disease and stroke statistics—2022 update: A report from the American Heart Association. Circulation, 145(8).

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Ullah, M., Hamayun, S., Wahab, A., Khan, S. U., Qayum, M., Ullah, A., Rehman, M. U., Mehreen, A., Awan, U. A., & Naeem, M. (2023). Smart technologies used as smart tools in the management of cardiovascular disease and their future perspective. Current Problems in Cardiology, 48(11), 101922.

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Upadhya, B., & Kitzman, D. W. (2020). Heart failure with preserved ejection fraction: New approaches to diagnosis and management. Clinical Cardiology, 43(2), 145–155.

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: Vidal-Almela, S., Czajkowski, B., Prince, S. A., Chirico, D., Way, K. L., Pipe, A. L., & Reed, J. L. (2020). Lessons learned from community- and home-based physical activity programs: A narrative review of factors influencing women’s participation in cardiac rehabilitation. European Journal of Preventive Cardiology, /28/7/761/6145608(6145608?login=false)

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan: World Health Organization. (2023). Cardiovascular diseases. World Health Organization.

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