Heart Disease Self-management for African American Older Adults: Outcomes of an Adapted Evidence-Based Intervention

Abstract

Background and Objectives To assess the impact of an evidence-based self-management intervention adapted through a community-engaged process for African American midlife and older adults with heart disease and/or cardiovascular risk factors. Research Design and Methods Adults 50 years and over, living in or near Detroit, Michigan, with diagnosed heart disease or >2 major risk factors for heart disease, were randomized to a 7-week group-format program called Take Heart, or a usual care control group. Take Heart included education about heart disease and support for behavioral lifestyle change, using a goal-setting process based on self-regulation theory. Outcome data were collected via telephone surveys at baseline and one year from baseline. Primary outcomes were self-reported emergency department visits and hospitalizations in the last year. Secondary outcomes were health-related quality of life (PROMIS-29 Adult Profile) and cardiac symptom burden. Results A total of 453 participants enrolled (74% female, 84% African American, mean age 65.4 years; 55% with diagnosed heart disease and 45% with risk factors only); 362 provided baseline and follow-up data. Using generalized linear and binomial regression models, at 12-month follow-up, there were no significant differences between intervention and control groups in ED visits or hospitalizations. Intervention vs. control participants had greater improvements in PROMIS fatigue (p=0.003) and sleep (p=0.04) subscales as well as cardiac symptom burden (p=0.04). Discussion and Implications The Take Heart intervention was associated with modest improvements in sleep, fatigue, and cardiac symptom burden. Take Heart was well-received and has potential for dissemination by agencies serving older adults.