proof positive - UCLA School of Nursing

transforming nursing science
AURELIA MACABASCO-O’CONNELL
In her efforts to determine the most
effective ways of educating low-income
underserved minority populations on
reducing their cardiovascular risk factors
and improving their health, Dr. Aurelia
Macabasco-O’Connell recently added a
biological component to research that was
once purely behavioral.
Macabasco-O’Connell, an assistant
professor at the UCLA School of Nursing,
has become interested in using biomarkers
– early biological indicators of disease
risk – to screen patients for left ventricular
dysfunction. The goal is to identify these
patients at a time when interventions to
prevent further progression toward heart
failure are most likely to succeed.
Macabasco-O’Connell’s research team
has focused on B-type natriuretic peptide
(BNP), a hormone secreted from the heart
as it starts to stretch. Detectable in a simple
blood test, BNP has been shown to be
elevated in patients with heart failure.
Macabasco-O’Connell’s group is seeking
to determine whether BNP can be used as
an early screening tool for patients who
have left ventricular dysfunction but
remain without symptoms. A pilot study
with a low-income, uninsured Hispanic
population found that BNP was useful
in detecting asymptomatic patients as
confirmed by the gold standard for
diagnosis, echocardiography.
“Many of these patients were walking
around thinking there was nothing wrong
with their heart despite knowing they
had high blood pressure and diabetes,
which are risk factors for developing heart
failure,” Macabasco-O’Connell says. “The
BNP measurement provided us with an
opportunity to educate these patients
about the importance of treating these
risk factors by explaining to them that
there was already some dysfunction even
though they didn’t yet feel it.”
Macabasco-O’Connell hopes to be
able to confirm the utility of BNP blood
tests in a larger study. She is currently
targeting a younger population, going into
the community to conduct screenings
that are designed to determine whether
left ventricular dysfunction can be found
even earlier – and whether such screenings
can improve community awareness and
enhance efforts to promote preventive
strategies.
“Too often, particularly among lowincome,
uninsured and underinsured
patients, we detect problems only when
patients end up in the emergency room
and have full-blown heart failure,”
Macabasco-O’Connell says. “By that point,
treatment is more challenging and these
patients typically need to be hospitalized
and re-hospitalized, which is both a
burden to them and a high cost to the
health care system. Biomarkers, combined
with education, offer an opportunity to
detect these patients earlier, get them into
the system, and prevent more of them
from reaching that point.”
10 UCLA SCHOOL OF NURSING fall 2010