EBP Project.

Submit EBP project with Implementation Plan and Evaluation Plan.  Note EBP plan should resemble plan on page 248 of the Melnyx text.

EvidenceTable Worksheet

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I. PICOT Question: (P) In patients with risk factors for CAD (I) how does exposure to extreme life stressors (C) vs patients with no known risk factors (I) contribute to the development of an acute STEMI/NSTEMI (T) in a 1-year time frame.

Running head: Evidence Table Worksheet 1

Evidence Table Worksheet 2

Will you have a comparison group or will subjects be their own controls?

I will make my derivations dependent on the comparison group I picked concerning the statistical meaning of the study results procured.

2. Is a ‘time’ appropriate with your question—why or why not?

Yes, for the reason that CAD patient require ample time when educated them about nursing interventions in order to record gradual change in risk factors.

II. Evidence


(database) ex: Cochran

Study #1

Study #2

Study #3

Study #4

Study #5


(p) Population

Men and women between 25-60 years.

Included CAD participants were from all gender and age.

CAD participants from all age and gender.

90 CAD patients averaged 59.3 years.

Adults above or equal to 64 years.

Involved CAD participant from all ages and gender.

(I) Intervention

Teaching CAD patients about healthy living lifestyles.

Modifying CAD risk factors.

Fractional flow reserve – guided strategy

Flexible health program

Nutritious eating plan

Maintaining the selected lifestyle with healthy activities

(c) Comparison

Patients with no risk factors didn’t receive teachings on modifiable risk factors.

Improper risk factors modification

No use of educational programs

Mediations were not used to patients with no known risk factors.

Living unhealthy lifestyle.

Inactive and unhealthy lifestyle.

(o) Outcome

Estimated 24% decrease of risk for patients to develop CAD

CAD patients supported by patient interventions reduced their anxiety feeling, plus the progression of cardiovascular failure reduces with smoking cessation while also maintaining systolic pulse.

The fractional flow reserve-guided strategy helped specialists to monitor the health status of CAD patients.

participants who used mobile health mediations complied well with medicines intake that significantly reduced coronary heart disease progression.

The study showed DASH diets reduces the risk of developing heart failure by 30%

Healthy lifestyle reduced the rate of CAD progression

(t) time

7 years

1 year

5 years

30 days

over 21.5 years


III. Evaluation Table

Level II



Sample size: Adequate?

Major Variables:

Independent Dependent

Study findings: Strengths and weaknesses

Level of evidence

Evidence Synthesis

Fung et al. (2016)

Quantitative, a prospective analysis

6817, satisfactory

CAD prevalence was the dependent variable while lifestyle modification was the independent variable.

Specialists have discovered CAD patients given healthy teachings about modifiable risk factors is reducing. Satisfactory research instrument was used to measure the quality. Study’s limitation was lack of accessing confounding factors, for instance utilization of medicines in management approaches, patient’s functional status, and the severity of prevailing concomitant


Level I

The study’s results revealed that reducing CAD stressors improved the quality of life of patients. for example, researchers used an eating pattern as a modifiable appraisal instrument that is set up on the premise that there are inadequate appraisal tools that don’t require extensive time and examination in the forecast of CAD risk. The analysis was therefore projected to control the development of such instrument by showing a dynamically compelling methodology by which to separate CAD risk over dietary supervision.

Levy et al. (2018).

Analysis of literature using quantitative approach



Nutrition program was independent variable while CAD prevalence was dependent variable.

Study shows that, CAD patients find it convincing and useful in managing their conditions using phone services. An efficient investigation and meta-survey of 27 novel researches was included in the examination, and the findings revealed that having no distinctions in death rates about the phone plus a control population demonstrating a comparative dimension of sufficiency. The phone provision mediations came with benefits of reduce tension scores, lower systolic pulse, lower depression scores, quitting smoking, and less admissions.

Level II


The study shows how psychological stressors affected CAD patients exposing them to risk of future illnesses. When the underlying issue become the episodes of heart failure, then it becomes relentless to maintain patient care as an investment, even in circumstances where patient have been diagnosed with an uncommon cardiac arrest.

Lee et al. (2018).

Analysis of literature using quantitative approach


The dependent variable was monitoring CAD patient’s status, and the independent variable was fractional flow reserve-guided strategy.

The wellbeing results of CAD patients can be easily analyzed with the partial flow reserve-guided technique. Articles beyond 5 years were selected as a way of measuring the quality of this study. The significant limitations are the execution of the faulty real instrument for checking and data examination and moderate headway of prominent obstructive physiology progresses achieving prohibitions in the midst of the data gathering process.

Level IV

The assessment was completed to make allowances concerning the meaning of standard screening in patients with CAD to screen their prosperity status and offer perfect interventions.

Giuliano et al. (2017)

Quantitative, a randomized controlled trial

90, quite adequate

Independent – medication reminders and education; Dependent – health status in patients with CAD

This examination demonstrated that patients would by and large show higher levels of exactness in their consistency element, suggesting that texts could be a doable methodology for enabling consistency with the dietary changes. The assessment’s primary quality is the use of ANOVA in light of the fact that the example size is minimal. The restriction is that the data gathering process required only 30 days, which isn’t adequate to consider each possible difference.

Level II

The overall self-revealed adherence didn’t differentiate altogether between social events that got medication refreshes and educational works, educational text messages just or no texts by any means. Thus, content illustrating and phone support may be conceivably beneficial enhancements; notwithstanding, they will likely not be fruitful all alone. Regardless, utilizing the two methods may be considerably stronger than using either procedure uninhibitedly.

Blaum et al. (2019)

Quantitative study, prospective analysis

4,490, adequate

Dependent- incidence of CAD; Independent dieting approach

Coronary disease recorded only a 21% diminishing in risk with modifiable changes. The essential quality is using arranged data gotten in the midst of the hour of over 21 years. The principal impediment is the usage of just a single estimation tool to perform information examination.

A successful reduction in various contributing factors to cardiovascular failure may acquire an all the huger decline in the risk of heart failure. Lifestyle modifications are critical while alleviating CAD.


Blaum, C., Brunner, F. J., Kröger, F., Braetz, J., Lorenz, T., Goßling, A., … & Waldeyer, C. (2019). Modifiable lifestyle risk factors and C-reactive protein in patients with coronary artery disease: Implications for an anti-inflammatory treatment target population. European journal of preventive cardiology, 2047487319885458.

Fung, T. T., Pan, A., Hou, T., Mozaffarian, D., Rexrode, K. M., Willett, W. C., & Hu, F. B. (2016). Food quality score and the risk of coronary artery disease: A prospective analysis in 3 cohorts. The American Journal of Clinical Nutrition, 104(1), 65–72. doi: 10.3945/ajcn.116.130393

Giuliano, C., Parmenter, B. J., Baker, M. K., Mitchell, B. L., Williams, A. D., Lyndon, K., … & Levinger, I. (2017). Cardiac rehabilitation for patients with coronary artery disease: a practical guide to enhance patient outcomes through continuity of care. Clinical Medicine Insights: Cardiology, 11, 1179546817710028.

Lee, J. M., Doh, J. H., Nam, C. W., Shin, E. S., & Koo, B. K. (2018). Functional approach for coronary artery disease: Filling the gap between evidence and practice. Korean Circulation Journal, 48(3), 179-190. Doi: 10.4070/kcj.2017.0393

Levy, A. E., Huang, C., Huang, A., & Ho, P. M. (2018). Recent approaches to improve medication adherence in patients with coronary heart disease: Progress towards a learning healthcare system. Current atherosclerosis reports, 20(1), 1-9.

My PICOT question is,



(P) In patients with risk factors for CAD (I) how does exposure to extreme life stressors (C) vs patients with no known risk factors (I) contribute to the development of an acute STEMI/NSTEMI (T) in a 1-year time frame. 


Stressful life events, such as natural calamities, financial crises, terroristic attacks and wars, are known to be life-threatening acute triggers for cardiac events, as are positive emotionally charged events (sport matches and Christmas and New Year’s holidays), thus worsening the prognosis in vulnerable individuals. Chronic stressors such as negative psychosocial factors represent modifiable risk factors that could be linked to adverse cardiac prognosis and the mortality rate worldwide. The international INTERHEART case control study proved that psychosocial factors were significantly related to acute myocardial infarction, with an odds ratio. Further meta-analyses of prospective observational studies found that certain psychosocial factors, such as social isolation and loneliness, were associated with a 50% increased risk of CVD; work-related stress showed similar results, with a 40% risk of new CV events. (Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F., Bianchi, M., Rovesti, M., & Roccia, M. G. 2018) 




Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F., Bianchi, M., Rovesti, M., & Roccia, M. G. 


(2018). Stress and Inflammation in Coronary Artery Disease: A Review 


Psychoneuroendocrineimmunology-Based. Frontiers in immunology, 9, 2031. 







Cardiovascular Disease


Cardiovascular disease posits a major cause of premature deaths and disability throughout the world and contributes to a significant increase in healthcare costs, particularly in medication, healthcare services, and production loss. Specifically, heart diseases and stroke accommodate the highest prevalence rate in the USA; accommodate an average of 610,000 and 365,000 annual deaths from CVD (CDC, 2015). Similarly, every year, CVD causes the USA approximately, $207 billion for medication, healthcare services, and productivity loss. Noteworthy, heart diseases and stroke incidences vary with factors such as ethnicity, gender, age, and individuals with certain disorders. Similarly, the project accommodates notable articulations on intervention, comparison, outcome, and time as a fundamental consideration in heart diseases and stroke in the USA. Thus, an enriched articulation on heart diseases and stroke are underscoring for the project presentation.


According to (Mayo Clinic, 2018), Heart disease describes a condition that affects the heart; including blood vessels diseases arrhythmias, and other heart defects. Significantly, the heart disease is interchangeable for the CVD, articulating on the infections involving narrowed or blocked blood vessels, causing a heart attack, chest pain, and stroke, among other clinical presentations. Similarly, (Mayo Clinic, 2018) acknowledges that many CVD is preventable and treatable with healthy lifestyle choices.


Cardiovascular diseases posits an undying cause of death in the USA, projected at 840, 678 deaths in 2016, averagely one in three deaths (Salim et al. 2020). Similarly, between 2013 and 2016 121.5 million adults Americans presented notable for of the CVD. Notably, between 2013 and 2015 direct and indirect costs of managing the CVD in the USA, recorded $213.8 billion and $137.4 billion respectively. Statistically, between 2013 and 2016, 57.1% of non-HN black females and 60.1% of non-HN black males presenting CVD manifestations (Salim et al. 2020). According to the researcher causes of the CVD Include atherosclerosis resulting from an unhealthy diet, lacking exercise, overweight, and smoking. In the epistemology studies, risk factors such as age, sex, family history, smoking, chemotherapy and radiation drugs, high blood pressure, poor diet, obesity, physical inactivity, stress, and poor hygiene are underscoring risk factors in the CVD (Mayo Clinic, 2018). Thus, heart disease epistemological indicates the patterns, causes, risk factors, and specific populations in the USA.

Clinical Presentations

Cardiovascular disease acclaims clinical presentations that may differ between men and women. According to (Mayo Clinic, 2018), men present significant chest pain that women and women clinical presentations such as shortness in breathing, nausea, and fatigue are more evident than in men. Admittedly, the general clinical presentation of the CVD includes chest pet, and discomfort, , tightness pressure ,pain, numbness, and weakness, and pain regions such as neck, jaw, upper abdomen, back, and throat (Mayo Clinic, 2018). Thus, prominent manifestations such as chest pain, shortness of breath, and fainting prompt a patient to see a doctor for diagnosis and clinical management.


The CVD complication results from heart arrhythmias, and dilated cardiomyopathy and, heart defects, heart infections and, atherosclerotic diseases. According to (Mayo Clinic, 2018), heart disease and stroke complications include heart failure, heart attack, stroke, peripheral artery diseases, cardiac arrest, and aneurysm. Therefore, a comprehensive diagnosis should accommodate heart disease complications for evidence-based case management.


Heart diseases acclaim several diagnosis methods and procedures in clinical settings for effective case identification and management among patients. Some diagnoses and stress include X-ray, ECG, exercise stress test, echocardiography, blood test, coronary angiography, MRI scan, CT scans, and radionuclide test (Salim et al. 2020). Thus, identifying appropriate diagnosis methods in clinical testing is necessary for an effective outcome and heart disease management.

Conclusion with PICOT Question

In conclusion, understanding the definition of epidemiological studies, clinical presentations, complication, diagnosis, and PICOT question provide an enriched articulation on heart disease and stroke management in the USA. (P) In the patient with risk factors for CVD (I), how does exposure behavior such as smoking and physical inactivity (C) versus a patient with limited and unknown risk factors (I) contribute to CVD treatment (T) in two years’ time frame?


Centers for Diseases Control and Prevention. (2015). Heart Disease Facts.


Mayo Clinic. (2018). Heart Disease. https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118

Salim, V. et al. (2020). Heart Disease and Stroke Statistics—2020 Update: A Report from the American Heart Association. AHA Journals, 141, 9. https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000000757

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