Macrovascular complication in diabetes and evidence for the treatment & CVD risk reduction

Fifty thousand Black women, disproportionately affected by cardiovascular disease (CVD), die annually; 49% of Black women ≥ 20 years have CVD. Implementing proactive risk reduction is essential. The purpose of this community - based pilot was to test the feasibility of a program combining self-care education with wireless individualized feedback via a unique smartphone designed to appeal specifically to young Black women (YBW). Methods: Using church-based recruitment, 49 YBW (aged 25-45 years, 60% single) were randomized to treatment (TX) and control groups by church site. The TX group participated in 4 interactive self-care classes on CVD risk reduction. Each participant set individualized goals. Risk factor profiles (waist circumference (WC), BP, lipid panel by Cholestech [Alere]), medical and reproductive history and a battery of psychosocial instruments were assessed prior to classes and 6 months later. Participants were given smartphones with embedded accelerometers and WANDA-CVD, an application that delivered prompts and messages specifically for this pilot. For activity monitoring, phones were worn on the hip during waking hours. Participants obtained and transmitted BP measurements wirelessly via the phone. Changes over time were measured with paired t-tests and linear regression controlling for age and weight. Effect sizes were calculated using Cohen’s D. Results: In risk factor profiles, significant differences favoring the TX group occurred in DBP, WC, and TC/HDL ratio; similar changes in triglycerides yielded a medium-large effect size (Table). TX participants had greater drops in stress, anxiety, and better adherence to heart healthy habits. Conclusion: These interim pilot data validate the feasibility of a combined education/wireless monitoring-feedback program in YBW. Further testing in a large randomized trial is warranted to determine long-term effects on behavior change and cardiac risk profiles in this high risk population.

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Interactive Participatory Audit and Feedback (IPAF): Theory-based development and multi-site implementation outcomes with specialty clinic staff

10.21203/rs.3.rs-26043/v2 ◽

2020 ◽

Author(s):

Edmond Ramly ◽

Diane Lauver ◽

Andrea Gilmore-Bykovskyi ◽

Christie M Bartels

Keyword(s):

Risk Reduction ◽

Self Regulation ◽

Self Determination Theory ◽

Self Determination ◽

Audit And Feedback ◽

Evidence Based ◽

Cvd Risk ◽

Frontline Staff ◽

Target Behaviors ◽

Implementation Outcomes

Abstract Background: Theory-based implementation strategies, such as audit and feedback (A&F), can improve adoption of evidence-based practices. However, few strategies have been developed and tested to meet the needs of specialty clinics. In particular, frontline staff can execute CVD risk-reduction protocols, but A&F strategies to support them have not been well examined. Our objective was to develop and evaluate a novel A&F strategy, Interactive Participatory A&F (IPAF). Methods: We developed IPAF by combining theories to inform staff goals (Self-Regulation Theory) and address their psychological needs for relatedness, autonomy, and confidence (Self-Determination Theory). We facilitated IPAF fidelity by developing a theory-based facilitation tool: a semi-structured worksheet to guide flexible discussion of target behaviors, perceived barriers, goals, and action plans. We evaluated IPAF in the context of eight quasi-experimental implementations in specialty clinics across two health systems. Following a Hybrid Type 2 effectiveness-implementation design, we reported intervention outcomes for CVD risk-reduction elsewhere. This paper reports implementation outcomes associated with IPAF, focusing on feasibility, acceptability, fidelity, and adoption. We evaluated implementation outcomes using mixed-methods data including Electronic Health Records (EHR) data, team records, IPAF worksheets, and staff questionnaire responses. Results: Eighteen staff participated in 99 monthly, individual, synchronous (face-to-face or by phone) IPAF sessions during the first six months of implementation. Subsequently, we provided over 375 monthly feedback emails. Feasibility data revealed high staff attendance (90-93%) and engagement in IPAF sessions. Staff rated questionnaire items about acceptability of IPAF highly. IPAF records and staff responses demonstrated fidelity of delivery and receipt of IPAF. Adoption of target behaviors increased significantly (all P-values < 0.05) and was maintained for over 24 months. Conclusions: We developed and evaluated an interactive participatory A&F strategy with frontline staff in specialty clinics to improve implementation of evidence-based interventions. The IPAF toolkit combines two complementary theories: Self-Regulation Theory and Self-Determination Theory. Findings support feasibility, acceptability, and fidelity of IPAF, and staff adoption and maintenance of target behaviors. By evaluating multi-site implementation outcomes, we have extended prior research on clinic protocols and A&F beyond primary care settings and providers.

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Evaluating Worksite CVD Risk Reduction Programs

AAOHN Journal ◽

10.1177/216507999003800907 ◽

1990 ◽

Vol 38 (9) ◽

pp. 448-454 ◽

Cited By ~ 1

Author(s):

Andrea Foote ◽

John C Erfurt

Keyword(s):

Risk Reduction ◽

Cvd Risk

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Evolocumab in Combination with Statins for CVD Risk Reduction: An Evidential Review

Journal of Cardiovascular Disease Research ◽

10.5530/jcdr.2018.2.13 ◽

2018 ◽

Vol 9 (2) ◽

pp. 45-53

Author(s):

Roopa Satyanarayana Basutkar ◽

Tenzin Tsundue ◽

Hema Siva ◽

Raja Durai ◽

Sivasankaran Ponnusankar

Keyword(s):

Risk Reduction ◽

Cvd Risk

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Different outcomes for different interventions with different focus!— A cross-country comparison of community interventions in rural Swedish and US populations

Scandinavian Journal of Public Health ◽

10.1177/14034948010290021801 ◽

2001 ◽

Vol 29 (56_suppl) ◽

pp. 46-58 ◽

Cited By ~ 1

Author(s):

L. Weinehall ◽

C. Lewis ◽

A.N. Nafziger ◽

P.L. Jenkins ◽

T.A. Erb ◽

...

Keyword(s):

Risk Factors ◽

New York ◽

Risk Reduction ◽

New York State ◽

Reference Population ◽

Cvd Risk ◽

Cross Sectional ◽

York State ◽

The Us ◽

Cross Sectional Studies

Objectives: There is a need among healthcare providers to acquire more knowledge about small-scale and low budget community intervention programmes. This paper compares risk factor outcomes in Swedish and US intervention programmes for the prevention of cardiovascular disease (CVD). The aim was to explore how different intervention programme profiles affect outcome. Methods: Using a quasi-experimental design, trends in risk factors and estimated CVD risk in two intervention areas (Norsjö, Sweden and Otsego- Schoharie County, New York state) are compared with those in reference areas (Northern Sweden region and Herkimer County, New York state) using serial cross-sectional studies and panel studies. Results: The programmes were able to achieve significant changes in CVD risk factors that the local communities recognized as major concerns: changing eating habits in the Swedish population and reducing smoking in the US population. For the Swedish cross-sectional follow-up study cholesterol reduction was 12%, compared to 5% in the reference population ( p for trend differences < 0.000) . The significantly higher estimated CVD risk (as assessed by risk scores) at baseline in the intervention population was below that of the Swedish reference population after 5 years of intervention. The Swedish panel study provided the same results. In the US, both the serial cross-sectional and panel studies showed a >10% decline in smoking prevalence in the intervention population, while it increased slightly in the reference population. When pooling the serial cross-sectional studies the estimated risk reduction (using the Framingham risk equation) was significantly greater in the intervention populations compared to the reference populations. Conclusions: The overall pattern of risk reduction is consistent and suggests that the two different models of rural county intervention can contribute to significant risk reduction. The Swedish programme had its greatest effect on reduction of serum cholesterol levels whereas the US programme had its greatest effect on smoking prevention and cessation. These outcomes are consistent with programmatic emphases. Socially less privileged groups in these rural areas benefited as much or more from the interventions as those with greater social resources.

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Reduced cardiovascular morbidity in patients with hemophilia: results of a 5-year multinational prospective study

Blood Advances ◽

10.1182/bloodadvances.2021005260 ◽

2021 ◽

Author(s):

Paul Van Der Valk ◽

Michael Makris ◽

Kathelijn Fischer ◽

Robert C Tait ◽

Pratima Chowdary ◽

...

Keyword(s):

Risk Reduction ◽

Risk Model ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Clotting Factor ◽

Cvd Risk ◽

Multicenter Observational Study ◽

Clotting Factor Concentrates ◽

Prospective Multicenter Observational Study

Hemophilia is a congenital bleeding disorder caused by low clotting factor VIII or IX levels. Life expectancy of people with hemophilia (PWH) has increased with the availability of clotting factor concentrates. At the same time, the incidence of cardiovascular disease (CVD) has increased. In retrospective studies there are conflicting data if, despite this increase, the incidence is still lower than in the general population. We prospectively compared the incidence of CVD in PWH with the predicted incidence. This prospective, multicenter, observational study included adult PWH (>30y) from the Netherlands and United Kingdom (UK). They were followed for a 5-year period and CVD incidence was compared with a predicted event rate based on the QRISK2-2011 CVD risk model. The primary endpoint was the observed fatal and nonfatal CVD incidence after 5 years compared to the estimated events and in relation to severity of hemophilia. The study included 709 patients, of whom 687 (96.9%) completed 5 years follow up or reached an endpoint. For 108 patients the QRISK score could not be calculated at inclusion. For the remaining 579 fewer CVD events were observed than predicted: 9 versus 24 (RR 0.38; 95% CI: 0.18 - 0.80 p=0.01), corresponding with an absolute risk reduction of 2.4%. Severe hemophilia treated on demand had the highest risk reduction. There was no statistical significant relation between severity of hemophilia and incidence of CVD. In hemophilia a lower than predicted CVD incidence was found, supporting the theory that hemophilia protects against CVD. The study is registered at www.clinicaltrials.gov (identification number NCT01303900).

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1107Reduction of cardiovascular disease risk factors in rural, medically under-served, socioeconomically distressed, high-risk individuals: a randomized controlled trial

European Heart Journal ◽

10.1093/eurheartj/ehz748.0001 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Moser ◽

M L Chung ◽

F Feltner ◽

T A Lennie ◽

M J Biddle

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Risk Reduction ◽

Controlled Trial ◽

Self Care ◽

Density Lipoprotein ◽

Control Group ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Randomized Controlled

Abstract Background People in rural, socioeconomically distressed areas of the world suffer from marked cardiovascular disease (CVD) disparities. Despite the CVD disparities seen in rural, distressed areas, efforts directed toward CVD risk reduction and prevention are limited. We conducted a randomized, controlled trial to determine the effect of an individualized, culturally appropriate, self-care CVD risk reduction intervention (HeartHealth) compared to referral of patients to a primary care provider for usual care on the following CVD risk factors: tobacco use, blood pressure, lipid profile, body mass index, depressive symptoms, and physical activity levels. Methods The study protocol and intervention were developed with a community advisory board of lay community members, business owners, local government officials, church leaders, and healthcare providers. We enrolled 355 individuals living in Appalachia with two or more CVD risk factors. The intervention was delivered in person to groups of 10 or fewer individuals over 12 weeks. In the first session, participants chose their CVD risk reduction goals. HeartHealth was designed to provide participants with self-care skills targeting CVD risk reduction while reducing barriers to risk reduction found in austere rural environments. The targeted CVD risk factors were measured at baseline and 4 and 12 months post-intervention. Repeated measures data were analyzed with mixed models. Results More individuals in the intervention group compared to the control group met their lifestyle change goal (50% vs 16%, p<0.001). The intervention produced a positive impact on systolic blood pressure (p=0.002, time X group effect), diastolic blood pressure (p=0.001, time x group), total cholesterol (p=0.026, time x group), high density lipoprotein (p=0.002, time x group), body mass index (p=0.017, time x group), smoking status (p=0.01), depressive symptoms (p=0.01, time x group), and steps per day (p=0.001, time x group). Compared to the control group, improvement was seen at 4 months in these risk factors and the positive changes were maintained through 12 months. There were no differences seen across time by group in low density lipoprotein or triglyceride levels. Conclusion Interventions like HeartHealth that focus on self-care and that are derived in collaboration with the community of interest are effective in medically underserved, socioeconomically distressed rural areas. Acknowledgement/Funding Patient Centered Outcomes Research Institute

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