Integration of implementation science in cardiovascular behavioral medicine.

Abstract

Cardiovascular behavioral medicine has significantly advanced the knowledge base regarding the mechanisms by which psychological and behavioral factors can impact cardiovascular function and has developed clear links between these factors and cardiovascular health and disease. More recent work has established numerous behavioral interventions that are efficacious, and in several cases demonstrated to be effective. However, despite these significant advances, translation to broad, real-world uptake and utilization has not been well studied, with consequential profound implications for health equity. The purpose of this article is to review what is known about effective implementation strategies to support the uptake of behavioral medicine interventions to improve cardiovascular health, to underscore the potential for developing additional implementation strategies for wide-scale uptake of effective cardiovascular behavioral medicine interventions, and to discuss the potential for developing additional implementation approaches while conducting early stage efficacy studies in this area.

If not us, who? If not now, when? Paths forward in science, patient care, and training to maximize the impact of cardiovascular behavioral medicine.

“…One, we need to identify the evidence-based interventions and practices ready for implementation science work and assertively move forward on this front. As is argued in this issue’s review by Stoney and colleagues (2022) from the National Heart, Lung, and Blood Institute (NHLBI), there is now ample evidence for the efficacy of behavioral interventions for a variety of health behaviors (physical activity, dietary behaviors, tobacco use, and medication adherence) and certain sleep disorders (obstructive sleep apnea and insomnia). However, the evidence base for successful implementation of these interventions within health care systems or communities is severely lacking.…”

“…We urge all CVBM investigators to carefully consider their practical recommendations. Relatedly, Stoney et al (2022) describe and advocate for implementation science approaches that are adapted to the social determinants of health (the conditions in the environments in which people live, learn, work, play, etc.) of the communities the interventions are intended to benefit.…”

“…We believe that the nature of both human behavior and the environments within which behaviors occur requires that interventions be customizable to individual patients within their unique contexts. We can adhere to the principles of human behavior that inform the interventions we test in clinical trials, while allowing for more flexible delivery of those interventions to also address the implementation science agenda (see Stoney et al, 2022). We see examples of this in the collaborative/integrated care intervention arms of the IMPACT trial (Unützer et al, 2002) and the COPES (Davidson et al, 2010) and CODIACS (Davidson et al, 2013) trials, in the emerging N = 1 trial models (Lillie et al, 2011), and in the potential use of personalized, mHealth interventions (see Rollman et al, 2022 in this issue).…”

“…Concerning the second question, we believe that the time for change is now. Our field has generated sufficient evidence to move full steam ahead with a research agenda emphasizing clinical trials and implementation science (Stoney et al, 2022), and we have strong exemplars in integrated cardiovascular care (Gaffey et al, 2022; Sears et al, 2022; Vela & Feingold, 2022) and training (Sall et al, 2022) that can be replicated elsewhere. But where to start?…”

“…Successful efficacy trials, in turn, will generate the evidence needed to justify future implementation studies. In their review, Stoney et al (Stoney et al, 2022) discuss the utility of incorporating implementation science aspects (e.g., assessing barriers to uptake and exploring initial implementation strategies) into the designs of trials at this earlier stage. Across this work, it is also essential that we also expand our notion of clinically relevant outcomes beyond reduced CVD morbidity and mortality to include mental health, social functioning, and health-related quality of life-a broad concept capturing physical, mental, and social outcomes of high relevance to stakeholders, including patients and their families (Centers for Disease Control and Prevention, 2000).…”