A Comparison of Live Counseling With a Web-Based Lifestyle and Medication Intervention to Reduce Coronary Heart Disease Risk

Abstract

IMPORTANCE Most primary care clinicians lack the skills and resources to offer effective lifestyle and medication (L&M) counseling to reduce coronary heart disease (CHD) risk. Thus, effective and feasible CHD prevention programs are needed for typical practice settings.OBJECTIVE To assess the effectiveness, acceptability, and cost-effectiveness of a combined L&M intervention to reduce CHD risk offered in counselor-delivered and web-based formats. DESIGN, SETTING, AND PARTICIPANTSA comparative effectiveness trial in 5 diverse family medicine practices in North Carolina. Participants were established patients, aged 35 to 79 years, with no known cardiovascular disease, and at moderate to high risk for CHD (10-year Framingham Risk Score [FRS], Ն10%).INTERVENTIONS Participants were randomized to counselor-delivered or web-based format, each including 4 intensive and 3 maintenance sessions. After randomization, both formats used a web-based decision aid showing potential CHD risk reduction associated with L&M risk-reducing strategies. Participants chose the risk-reducing strategies they wished to follow. MAIN OUTCOMES AND MEASURESThe primary outcome was within-group change in FRS at 4-month follow-up. Other measures included standardized assessments of blood pressure, blood lipid levels, lifestyle behaviors, and medication adherence. Acceptability and cost-effectiveness were also assessed. Outcomes were assessed at 4 and 12 months. RESULTSOf 2274 screened patients, 385 were randomized (192 counselor; 193 web): mean age, 62 years; 24% African American; and mean FRS, 16.9%. Follow-up at 4 and 12 months included 91% and 87% of the randomized participants, respectively. There was a sustained reduction in FRS at both 4 months (primary outcome) and 12 months for both counselor-based

Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers

“…Another potential explanation for our observed findings is that this intervention led patients to discuss CVD prevention with clinicians but did not overcome some patients' reluctance to initiate drug therapy. The increase in patients who refused LDL-cholesterol, mg/dL (SD) 133 (27) 132 (24) HDL-cholesterol, mg/dL (SD) 50 (16) 50 (13) Systolic blood pressure, mm Hg (SD) 137 (20) 136 (18) Diastolic blood pressure, mm Hg (SD) 84 (12) 84 (12) Drug-treated hypertension, % 82 (25) 82 (26) Current smoker, % 188 (57) 170 (54) CHD indicates coronary heart disease; CVD, cardiovascular disease; HDL, high-density lipoprotein; IQR, interquartile range; and LDL, low-density lipoprotein.…”

“…25 Several studies completed because this review have also demonstrated significant improvements in risk factor levels, and increased the use of preventive medication. 15,26,27 One difference between this study and most previous trials is that we used a pragmatic design with a waiver of informed consent that included all eligible patients receiving care at participating sites. Therefore, our findings may be more indicative of how this type of intervention performs in a general population rather than one limited to volunteer participants.…”

Prevalence of behavioral health disorders and associated chronic disease burden in a commercially insured health system: findings of a case–control study

“…In addition, the Charlson Comorbidity Index was calculated to examine the cumulative burden of medical comorbidity. The Charlson Comorbidity Index is a weighted score of 17 conditions which predicts the risk of 10-year mortality for patients with a range of these diagnosis-based comorbid conditions [26,27].…”

“…25 Major depression, single episode, in partial remission 296. 26 Major depression, single episode, in full remission 296. 3 Major depression, recurrent, unspecified 296.…”

Association of Sleep Duration with the Morbidity and Mortality of Coronary Artery Disease: A Meta-analysis of Prospective Studies

“…Genetic and lifestyle risk factors are thought to be associated with CAD [4][5][6]. The WHO has developed a series of recommendations based on these factors to prevent and control disease [3].…”