HEAR2T Reference Program
General Electric - San Jose Program
The overall objective of the HEAR2T Program at GE-SJ was to reduce the cardiovascular disease risk status of employees, retirees, and spouses of retirees, with special emphasis on those persons who were at highest risk for heart disease or stroke. Participants were encouraged to use work-site exercise facilities and a variety of health-oriented programs and services located in the community. Evaluation of the program included rates of participation in each phase of the project, change in risk factor status from baseline to a follow-up evaluation at 12-15 months, participant satisfaction with the program, and physician knowledge of and satisfaction with the program.
After program introduction and promotion, a cardiovascular risk assessment (CRA) questionnaire was sent to all GE-SJ employees, local GE-SJ retirees and the spouses of these retirees (total N = 1659). Responses were received from 1003 participants (60.5% response rate). Based on the results of the CRA, 690 persons (69%) were considered to be at high risk of heart attack or stroke and were invited to participate in a clinic risk factor screen conducted at the GE-SJ medical clinic. This evaluation included measurement of major CVD risk factors and a brief counseling session with the entire session lasting no more than 30 minutes. Of the 690 persons invited, 577 (82%) participated in the clinic risk factor screening. After evaluation of the CRA and the clinic risk factor screening data, 316 of the highest risk persons were invited to participate in the RN based counseling program, and all accepted this invitation.
Between 12 and 15 months after the baseline evaluations, all 1003 persons that completed the baseline CRA were sent a follow-up CRA and a participant satisfaction questionnaire. Those persons in the high risk-counseling program were invited back to a follow-up clinic risk factor screening. Overall, 672 persons returned a follow-up CRA (67%) and 613 (61%) a participant satisfaction questionnaire. Of the 316 participants enrolled in the high risk counseling program, 286 (91%) completed the follow-up CRA and clinic risk factor screening and 258 (82%) returned the participant satisfaction questionnaire.
The primary analyses have involved the responses to the CRA, clinic risk factor screen and participant satisfaction survey of the persons enrolled in the high risk counseling program. Satisfaction with the program among this group was exceptionally high, with 95% of respondents rating their overall satisfaction with the program as satisfied (50%) or very satisfied (45%), and when asked about the thoroughness and competence of the Program nurse, 86% rated her as very good (highest category). Major increases in the medical management of these high risk participants occurred as indicated by an increase in the number of participants on blood pressure lowering medication from 78 (27.3%) to 96 (33.6%) and on cholesterol lowering medications from 55 (19.2%) to 100 (35.0%) participants. There were significant improvements reported in nutrition, stress and exercise behaviors, while the reduction in the number of cigarette smokers was from 23 to 20. Significant reductions occurred in mean systolic (135 to 128 mm Hg; P < 0.001) and diastolic blood pressure (84 to 80 mm Hg; P < 0.001), serum total cholesterol (226 to 209 mg/dL): P < 0.001), LDL-cholesterol 149 to 132 mg/dL; P < 0.001), the total cholesterol/HDL-cholesterol ratio (5.9 to 5.2; P < 0.001) and triglyceride concentrations (192 to 173 mg/dL. Also, there were major shifts in the number of participants classified at high or very high risk at baseline to categories of low or increased risk at follow-up for each of these measures (see Figure1). Small reductions in body weight and fasting blood glucose were not significant.
Based on these results, we consider the high-risk identification and counseling components of the Stanford HEAR2T Program at GE-SJ was very successful. The CRA was completed by a higher than expected number of participants and successfully identified a group of persons at high risk for future CVD clinical events. The counseling program was successful in initiating a number of favorable lifestyle changes and enhancing the medical management of selected participants. Retention in the program was excellent (>90% at follow-up), and participant satisfaction with most components of the program was rated as very high. This success was achieved in a high risk population that travel away from the worksite for weeks at a time and during a period when a significant number of layoffs occurred.
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