Implementation of case management to reduce cardiovascular disease risk in the Stanford and San Mateo Heart to Heart randomized controlled trial: study protocol and baseline characteristics

Ma, Jun; Lee, Ky-Van; Berra, Kathy; Stafford, Randall S.

doi:10.1186/1748-5908-1-21

Cited by 14 publications

(12 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…New strategies are being pursued to further improve BP screening, treatment, and control in the health care system and in the community at large. [33][34][35] In turn, these strategies will help further reduce the burden of cardiovascular disease risk attributable to elevated BP.…”

Section: Discussionmentioning

confidence: 99%

Screening, Treatment, and Control of Hypertension in US Private Physician Offices, 2003–2004

Stafford

2008

Hypertension

Self Cite

View full text Add to dashboard Cite

Abstract-Essential hypertension is the most common diagnosis in US primary care settings for middle-aged persons andseniors. Yet, data on hypertension screening, treatment, and control in such settings are limited. We analyzed National Ambulatory Medical Care Survey data to examine the rates of and factors associated with hypertension screening, treatment, and control during US office visits in 2003 and 2004. Blood pressure was measured in 56% (95% confidence limits: 52% to 59%) of all visits by patients Ն18 years of age and in 93% (95% confidence limits: 89% to 96%) of hypertensive patient visits. Among the latter, 62% (95% confidence limits: 55% to 69%) were treated. Diuretics were the most commonly prescribed antihypertensive agents (46%; 95% confidence limits: 41% to 50%), and combination therapy was reported in 58% (95% confidence limits: 54% to 63%) of treated visits. Only 39% (95% confidence limits: 34% to 43%) of treated visits were at recommended blood pressure goals. The odds of not being screened for hypertension were notably greater for visits with a provider other than a primary care physician or cardiologist (10.0; 95% confidence limits: 5.5 to 16.7) and for nonwell care visits (5.6; 95% confidence limits: 3.6 to 8.3). Greater odds of not being treated for hypertension were noted by geographic region (South versus Northeast: 2.6; 95% confidence limits: 1.2 to 5.6) and visit type (first time versus return visits; 1.6; 95% confidence limits: 1.1 to 2.4). The odds of not having blood pressure controlled were greater for patients with comorbidities (1.6; 95% confidence limits: 1.1 to 2.4). In conclusion, more intervention efforts are needed to further reduce the gaps and variations in routine practice in relation to evidence-based practice guidelines for hypertension screening, treatment, and control. Data from the National Health and Nutrition Examination Survey (NHANES), a long-standing survey of the US noninstitutionalized civilian population, have drawn attention to continuing gaps in the prevalence, awareness, treatment, and control of hypertension in relation to US public health objectives and clinical practice guidelines. 1,3,4 The latest article based on NHANES 1999NHANES -2004 reported that the overall prevalence of hypertension was 29% in [2003][2004], with a clear trend of increasing prevalence with age, and Ϸ1 of 4 hypertensive patients were unaware of their hypertension. 1 These findings bolster the importance of the recommendation by the US Preventive Services Task Force that clinicians routinely screen adults aged Ն18 years for high BP. 5 The same article 1 that analyzed the data from NHANES 1999 -2004 also reported that, in 2003-2004, 65% of individuals with known hypertension reported to be taking antihypertensive medications, and 37% had their BP under control, defined as BP Ͻ140/90 mm Hg for nondiabetic patients and Ͻ130/80 mm Hg for diabetic patients. The 37% control rate reflected an 8% age-adjusted increase from 1999 to 2000, making it seem feasible to reach the Healthy People 2...

show abstract

Section: Discussionmentioning

confidence: 99%

Screening, Treatment, and Control of Hypertension in US Private Physician Offices, 2003–2004

Stafford

2008

Hypertension

Self Cite

View full text Add to dashboard Cite

show abstract

“…A total of 419 (41%) patients were eligible and provided informed consent to participate. Participants were men and women between the ages of 35 and 85 years who had moderately to severely elevated levels of major modifiable CVD risk factors with or without prior history of atherosclerotic CVD or diabetes mellitus 14. The study was approved by Institutional Review Boards at Stanford University and SMMC.…”

Section: Methodsmentioning

confidence: 99%

Case Management to Reduce Risk of Cardiovascular Disease in a County Health Care System

Berra²,

Haskell³

et al. 2009

Arch Intern Med

Self Cite

View full text Add to dashboard Cite

Background Case management (CM) is a systematic approach to supplement physician-centered cardiovascular disease (CVD) prevention efforts. Research is limited on its implementation and efficacy in low-income, ethnic minority populations. Methods We conducted a randomized clinical trial to evaluate a nurse and dietitian-led CM program for reducing major cardiovascular risk factors in low-income, primarily ethnic-minority patients in a county healthcare system, 63% of whom had Type II diabetes mellitus. The primary outcome was the Framingham risk score (FRS). Results A total of 419 patients at elevated risk of CVD events were randomized and followed for a mean of 16 months (81% retention). Mean FRS was significantly lower for the CM vs. UC group at follow-up (7.80 [95% CI, 7.21 to 8.38] vs. 8.93 [95% CI, 8.36 to 9.49]; P=.001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or 200 individuals receiving the intervention to prevent one event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering mean (SD) systolic (−4.2 [18.5] mm Hg vs. 2.6 [22.7] mm Hg; P=.003) and diastolic (−6.0 [11.6] mm Hg vs. 3.0 [11.7] mm Hg; P=.02) blood pressure for the CM vs. UC group. Conclusions Nurse and dietitian case management targeting multifactor risk reduction can lead to modest improvements in CVD risk factors among high-risk patients in low-income, minority populations receiving care in county health clinics.

show abstract

“…Convincing studies, including the Stanford Heart to Heart Project and the Diabetes Prevention Program, have shown efficacy of intensive individualized lifestyle counseling for sustained weight loss and CHD risk factor reduction[18-23]. Research also shows that lifestyle counseling in groups may be as effective for achieving weight loss[24-26] and more economical compared to individual counseling[25,27].…”

Section: Introductionmentioning

confidence: 99%

Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program

Drieling

Stafford

2011

BMC Public Health

Self Cite

View full text Add to dashboard Cite

BackgroundObesity exerts an enormous health impact through its effect on coronary heart disease and its risk factors. Primary care-based and community-based intensive lifestyle counseling may effectively promote weight loss. There has been limited implementation and evaluation of these strategies, particularly the added benefit of community-based intervention, in low-income Latino populations.DesignThe Vivamos Activos Fair Oaks project is a randomized clinical trial designed to evaluate the clinical and cost-effectiveness of two obesity reduction lifestyle interventions: clinic-based intensive lifestyle counseling, either alone (n = 80) or combined with community health worker support (n = 80), in comparison to usual primary care (n = 40). Clinic-based counseling consists of 15 group and four individual lifestyle counseling sessions provided by health educators targeting behavior change in physical activity and dietary practices. Community health worker support includes seven home visits aimed at practical implementation of weight loss strategies within the person's home and neighborhood. The interventions use a framework based on Social Cognitive Theory, the Transtheoretical Model of behavior change, and techniques from previously tested lifestyle interventions. Application of the framework was culturally tailored based on past interventions in the same community and elsewhere, as well as a community needs and assets assessment. The interventions include a 12-month intensive phase followed by a 12-month maintenance phase. Participants are obese Spanish-speaking adults with at least one cardiovascular risk factor recruited from a community health center in a low-income neighborhood of San Mateo County, California. Follow-up assessments occur at 6, 12, and 24 months for the primary outcome of percent change in body mass index at 24 months. Secondary outcomes include specific cardiovascular risk factors, particularly blood pressure and fasting glucose levels.Discussion and ConclusionsIf successful, this study will provide evidence for broad implementation of obesity interventions in minority populations and guidance about the selection of strategies involving clinic-based case management and community-based community health worker support.Clinical Trial RegistrationClinicalTrials.gov: NCT01242683

show abstract

Implementation of case management to reduce cardiovascular disease risk in the Stanford and San Mateo Heart to Heart randomized controlled trial: study protocol and baseline characteristics

Cited by 14 publications

References 33 publications

Screening, Treatment, and Control of Hypertension in US Private Physician Offices, 2003–2004

Screening, Treatment, and Control of Hypertension in US Private Physician Offices, 2003–2004

Case Management to Reduce Risk of Cardiovascular Disease in a County Health Care System

Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program

Contact Info

Product

Resources

About