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Even with the falling rates of cardiovascular deaths, the number of deaths attributable to sudden cardiac death keeps rising.[1] A total of 350000 events of sudden cardiac death are estimated to occur in the United States every year. Coronary artery disease often leads to complex electrical and structural remodeling of the heart due to myocardial injury. Structural and electrical changes occur simultaneously, and drive worsening pathologic change and increased risk for cardiac events. Anatomic scar often gives rise to conduction abnormalities that can lead to a fatal arrhythmia.[2] This remodeling is the root cause that precipitates ventricular arrhythmias, which often lead to sudden cardiac death. Cardiac remodeling occurs in response to stress, either functional stress or structural stress. This remodeling plays a vital role in the disease process that ensues. Initially, the electrical and structural remodeling helps in compensating the cardiac performance. But over time, these compensatory mechanisms often lead to pump failure and/or fatal arrhythmias.[3] Both atria and ventricles are affected by electrical remodeling. This process eventually leads to atrial fibrillation and fatal ventricular arrhythmias.[4] Structural remodeling of the heart can be physiologic growth occurring in response to exercise, pregnancy, or during the postnatal period. It can also be pathologic hypertrophy in response to neurohumoral activation, injury to the myocardium, or hypertension. Heart failure and malignant arrhythmia are often precipitated by pathological hypertrophy of the heart. However, they don’t occur with the physiological growth of the heart.[3]

The reversal or slowing of structural cardiac remodeling has occurred with the use of beta-blockers, aldosterone antagonists, and ACE inhibitors. They are beneficial in patients with ejection fraction less than 40 percent.[13] Cardiac resynchronization therapy (CRT) has been effective in alleviating the symptoms in electrical remodeling due to heart failure. It decreases the chances of sudden cardiac death in such patients. There is a certain degree of reversal of electrical remodeling of the heart with CRT.[14] These interventions can be supplemented by interprofessional coordination and communication. Nurses can play a vital role in management by motivational interviewing. There are vast numbers of regional educational programs which can provide critical information to the patients regarding their diseases and conditions. Nurses can play a role in guiding the patients towards these resources. Patient education has a beneficial effect on adherence to the interventions and regular follow-ups. Moreover, nurses can help by managing regular follow-ups. Referral to nutritionists and psychologists is also an important aspect. Since this condition requires lifestyle and diet changes as part of its management.[15] Pharmacists can play their role in management by overlooking the dosage, safety providing information about the appropriate time of medication ingestion and side effects, reviewing the medication refill history, and providing adherence interventions.[16] An interprofessional team of health professionals and clinicians can provide a collection of clinical protocols that lay the framework for the expertise of nurses and pharmacists. These collections of clinical protocols can include various steps like ordering laboratory investigations, prescribing, and managing the dose of medications related to a specific clinical condition. These are known as collective prescriptions. The use of collective prescriptions is a valuable strategy in providing effective healthcare to patients.[15] A collaborative approach by the interprofessional team can drive patient outcomes to positive results with minimal adverse effects. [Level 5]