A randomized trial of an intervention to improve use and adherence to effective coronary heart disease prevention strategies

Sheridan, Stacey; B., Draeger, Lindy; Pignone, Michael; Keyserling, Thomas C.; Simpson, Ross J.; Rimer, Barbara K.; Bangdiwala, Shrikant I.; Cai, Jianwen; Gizlice, Ziya

doi:10.1186/1472-6963-11-331

Cited by 67 publications

(59 citation statements)

References 38 publications

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“…Additionally, the timeframe of a majority of studies was between 6 and 12 months, and most studies were published within the past decade. RCTs were blinded with specific mention of study personnel blinded to allocation and grouping during the study and to data analysis, with the exception of three studies 19–21 .…”

Section: Resultsmentioning

confidence: 99%

Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis

Widmer

Collins

et al. 2015

Mayo Clinic Proceedings

333

242

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Objective To assess the potential benefit of digital health interventions (DHI) on cardiovascular disease outcomes (CVD events, all-cause mortality, hospitalizations) and risk factors compared to non-DHI interventions. Patients and Methods We conducted a systematic search of PubMed, MEDLINE, EMBASE, Web of Science, OVID, CINHAL, ERIC, PsychInfo, Cochrane, and CENTRAL from January 1, 1990 and January 21, 2014. Included studies examined any element of DHI (telemedicine, web-based strategies, email, mobile phones, mobile applications, text messaging, and monitoring sensors) and CVD outcomes or risk factors. Two reviewers independently evaluated study quality utilizing a modified version of the Cochrane Collaboration risk assessment tool. Authors extracted CVD outcomes and risk factors for CVD such as weight, BMI, blood pressure, and lipids from 51 full-text articles that met validity and inclusion criteria. Results DHI significantly reduced CVD outcomes (RR=0.61, (95% CI, 0.45–0.83), P=.002; I2=22%). Concomitant reductions in weight (−3.35 lbs, (95% CI, −6.08 lbs, −1.01 lbs); P=.006; I2=96%) and BMI (−0.59 kg/m2, (95% CI, −1.15 kg/m2, −0.03 kg/m2); P=.04; I2=94%) but not blood pressure (+4.95 mmHg, (95% CI, −4.5 mmHg, 14.4 mmHg); P=.30; I2=100%) were found in these DHI trials compared to usual care. Framingham 10 year risk percentages were also significantly improved (−1.24%; 95% CI −1.73%, −0.76%; n=6; P<0.001; I2=94%). Results were limited by heterogeneity not fully explained by study population (primary or secondary prevention) or DHI modality. Conclusions Overall, these aggregations of data provide evidence that DHI can reduce CVD outcomes and have a positive impact on risk factors for CVD.

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Section: Resultsmentioning

confidence: 99%

Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis

Widmer

Collins

et al. 2015

Mayo Clinic Proceedings

333

242

View full text Add to dashboard Cite

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“…Based on a previous study [12], we estimated that the within-practice intraclass correlation for change in systolic BP was zero and standard deviation was 16 mmHg. We assumed that the baseline difference in systolic blood pressure between African Americans and Whites would be approximately 5 mmHg.…”

Section: Methodsmentioning

confidence: 99%

The heart healthy lenoir project-an intervention to reduce disparities in hypertension control: study protocol

Halladay

Donahue

Hinderliter

et al. 2013

BMC Health Serv Res

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BackgroundRacial disparities in blood pressure control are well established; however the impact of low health literacy (LHL) on blood pressure has garnered less attention. Office based interventions that are created with iterative patient, practice and community stakeholder input and are rolled out incrementally, may help address these disparities in hypertension control. This paper describes our study protocol.Methods/designUsing a community based participatory research (CBPR) approach, we designed and implemented a cohort study that includes both a practice level and patient level intervention to enhance the care and support of patients with hypertension in primary care practices in a rural region of eastern North Carolina. The study is divided into a formative phase and an ongoing 2.5 year implementation phase. Our main care enhancement activities include the integration of a community health coach, using home blood pressure monitoring in clinical decision making, standardizing care delivery processes, and working to improve medication adherence. Main outcomes include overall blood pressure change, the differential change in blood pressure by race (African American vs. White) and health literacy level (low vs. higher health literacy).DiscussionUsing a community based participatory approach in primary care practice settings has helped to engage patients and practice staff and providers in the research effort and in making practice changes to support hypertension care. Practices have engaged at varying levels, but progress has been made in implementing and iteratively improving upon the interventions to date.Trial registrationClinicalTrials.gov NCT01425515.

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“…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.…”

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confidence: 99%

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

Persell

Brown

Lee

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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T he risk of developing cardiovascular disease (CVD) can be greatly reduced through lifestyle and medical therapies that address diet, overweight and obesity, smoking, dysplipidemia, hypertension, and diabetes mellitus. Irrespective of which factors are contributing on an individual's risk for the development of CVD, treatment with statins safely and effectively reduces morbidity and mortality from CVD. 1,2The recent American College of Cardiology/American Heart Association cholesterol treatment guideline emphasizes identifying and treating individuals at risk for developing CVD. 3 However, fewer than half of high-risk individuals are treated with statins. 4,5 Statin use is lower among blacks, 4,6 Hispanics, 5,6 the uninsured, 7 and poorer individuals. 8,9 Reducing the population burden of CVD and decreasing disparities will require maximizing the use of preventive strategies among all individuals likely to benefit from them.Statins may be underused for primary prevention for several reasons. Clinicians and patients may not readily appreciate increased CVD risk, particularly when risk comes from factors other than elevated cholesterol. 10,11 Patients may also Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states.Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, [12][13][14] Outreach interventions focused on addressing this risk could increase the number of high-risk patients who seek out treatment. 15Implementing population health management strategies in settings that serve large numbers of patients from low income and minority populations may be an effective way to reduce disparities. 16,17 In addition, testing strategies in safety net settings will help ensure that the study findings are applicable to low income and minority populations.We hypothesized that m...

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A randomized trial of an intervention to improve use and adherence to effective coronary heart disease prevention strategies

Cited by 67 publications

References 38 publications

Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis

Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis

The heart healthy lenoir project-an intervention to reduce disparities in hypertension control: study protocol

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

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