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Heart Disease on the Mend Project
(presented at the Annual Scientific Sessions of the American Heart Association, November 14, 2003)
Heart Disease on the Mend: A Multifactor Risk Reduction Program in the Medically Underserved.
William Haskell, Kathy Berra, Elizabeth Aries, Annette Clark, Dianne Christopherson, Shauna Duff, Jan George, Linda Klieman, Jeff Myll, Stanford University School of Medicine
Background:
Risk factors contributing to increased risk for cardiovascular disease (CVD) are well defined. Clinical trials have shown that multifactor risk reduction (MRR) reduces CVD morbidity and mortality. The challenge is to implement cost-effective MRR programs, especially for ethnic minority and low-income populations.
Purpose:
To test the effectiveness of a MRR program in the medically underserved.
Methods:
Persons at high risk for CVD were identified in settings where low-income patients obtain medical care in Santa Clara County California. Medical history and clinical screening confirmed eligibility. Eligible participants were randomized [2:1 - treatment (T) versus usual care (UC)] into the Heart Disease on the Mend (HDOM) yearlong MRR program. The MRR program used a physician-directed, nurse and dietitian case management approach that included lifestyle change and medical management.
Results:
Of the 148 persons randomized, 56% were female with mean age of 57 years (s.d. = 20.4). Ethnicity included 57% Hispanic, 10% Asian, 7% African American, 16% Caucasian and 10% other. Patient fluency in English: none = 45%, moderate = 22% and fluent = 33%. Presence of Type II diabetes (54%), dyslipidemia (67%), hypertension (70%) and obesity (38%) were the most common CVD risk factors at baseline. Data at 12 months were collected on 91% of patients. The MRR program produced significant reductions in major CVD risk factors during follow-up for T vs. UC. Risk status was lower at follow-up (6-month plus 12-month values) for T vs UC (ANCOVA) for the following risk factors: TC (mg/dL) UC = 199, T = 184 (p<.01), LDL-C (mg/dL) UC = 116, T = 104 (p<.01); TC/HDL-C UC = 4.8, T = 4.2 (p<.001), Tg (mg/dL) UC = 193, T = 174 (p=.06), fasting glucose (mg/dL) UC = 142, T= 129 (p<.01), SBP (mmHg) UC = 137, T = 128 (p<.001), DBP (mmHg) UC = 81, T 77 (P<.001), physical activity risk score UC = 11.6, T = 7.9 (p=.02), and nutrition risk score UC= 14.7, T= 13.0 (p=.02).
Conclusion:
HDOM achieved excellent retention and participation over 12 months and reduced most CVD risk factors in this low income mostly minority population. Such programs can help address the enormous societal need to provide access to known beneficial therapies to improve the health and well being of high risk underserved populations.
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