Chest Pain Observation Unit Risk Reduction Trial
| Status: | Completed |
|---|---|
| Conditions: | Angina, Pain |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Musculoskeletal |
| Healthy: | No |
| Age Range: | 30 - 100 |
| Updated: | 4/28/2018 |
| Start Date: | September 2007 |
| End Date: | January 2017 |
Brief Intervention to Promote Cardiovascular Risk Reduction in Patients Admitted to Chest Pain Observation Units
The purpose of this study is to determine whether a brief counseling intervention initiated
in the chest pain observation unit has a significant impact upon the health attitudes
(readiness to change) and cardiovascular risk-related behaviors (diet, exercise, and smoking)
of emergency department patients.
in the chest pain observation unit has a significant impact upon the health attitudes
(readiness to change) and cardiovascular risk-related behaviors (diet, exercise, and smoking)
of emergency department patients.
Increasingly, emergency department patients for whom a non-ischemic etiology of acute
coronary syndrome (ACS) symptoms cannot be identified undergo further evaluation to rule out
myocardial ischemia and appraisal of cardiovascular risk factors (CRFs) in chest pain
observation units (CPOUs). CPOU admission may represent a "teachable moment," but there has
been little research on the effectiveness of brief, practical interventions for
cardiovascular risk reduction in this population, despite the fact that the vast majority of
these patients have at least one modifiable CRF and many do not receive regular primary care
follow-up. The purpose of this study is to determine whether a brief counseling intervention
initiated in the CPOU has a significant impact upon health attitudes (readiness to change)
and cardiovascular risk-related behaviors (diet, exercise, and smoking). Based on the Health
Belief Model (HBM), the intervention is designed to provide patients with tailored
information on their cardiovascular risk, to negotiate goals for change, and to build
problem-solving skills. All participants who are admitted to the CPOU for evaluation of ACS
symptoms will be randomized to brief intervention (face-to-face counseling in the CPOU,
coupled with telephone counseling at 4 weeks) or to minimal intervention (booklet with
general information on CRFs) after a negative initial troponin measurement. We will conduct a
baseline survey and follow-up telephone interviews at 2- and 6-month to assess stage of
change and CRF-related behaviors. Linear mixed models and logistic regression (with
generalized estimating equations) will be used to compare continuous and dichotomous
behavioral outcomes across treatment arms, respectively. The proposed trial will evaluate the
feasibility and effectiveness of delivering brief interventions for cardiovascular risk
reduction in the CPOU setting, will provide insight into mechanisms of behavior change in
these patients, and will guide the development of future case management interventions.
coronary syndrome (ACS) symptoms cannot be identified undergo further evaluation to rule out
myocardial ischemia and appraisal of cardiovascular risk factors (CRFs) in chest pain
observation units (CPOUs). CPOU admission may represent a "teachable moment," but there has
been little research on the effectiveness of brief, practical interventions for
cardiovascular risk reduction in this population, despite the fact that the vast majority of
these patients have at least one modifiable CRF and many do not receive regular primary care
follow-up. The purpose of this study is to determine whether a brief counseling intervention
initiated in the CPOU has a significant impact upon health attitudes (readiness to change)
and cardiovascular risk-related behaviors (diet, exercise, and smoking). Based on the Health
Belief Model (HBM), the intervention is designed to provide patients with tailored
information on their cardiovascular risk, to negotiate goals for change, and to build
problem-solving skills. All participants who are admitted to the CPOU for evaluation of ACS
symptoms will be randomized to brief intervention (face-to-face counseling in the CPOU,
coupled with telephone counseling at 4 weeks) or to minimal intervention (booklet with
general information on CRFs) after a negative initial troponin measurement. We will conduct a
baseline survey and follow-up telephone interviews at 2- and 6-month to assess stage of
change and CRF-related behaviors. Linear mixed models and logistic regression (with
generalized estimating equations) will be used to compare continuous and dichotomous
behavioral outcomes across treatment arms, respectively. The proposed trial will evaluate the
feasibility and effectiveness of delivering brief interventions for cardiovascular risk
reduction in the CPOU setting, will provide insight into mechanisms of behavior change in
these patients, and will guide the development of future case management interventions.
Inclusion Criteria:
- At least one modifiable cardiovascular risk factor (smoking, hyperlipidemia,
hypertension, diabetes mellitus, obesity)
Exclusion Criteria:
- Patients who "rule-in" for myocardial ischemia at initial testing
- Terminally ill (expected to survive less than 3 months)
- Unavailable for 6-month follow-up
- Cannot be contacted by telephone
- Institutionalized persons (prisoners, nursing home residents)
- Unable to provide informed consent (impaired mental status, unable to speak English)
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