Abstract 12350: The Impact of an Electronic Best Practice Advisory on Patients’ Physical Activity and Cardiovascular Risk Profile

Abstract

Background: Regular physical activity (PA) is one of eight components of cardiovascular health and it is associated with numerous benefits including a lower risk of CVD. Promoting PA to sedentary patients in primary care can result in significant improvements in PA. The aims of this study were to implement a PA counseling intervention using an electronic best practice advisory (BPA), in a preventive cardiology clinic, and to assess changes in PA and CVD risk factors in a sample of patients enrolled in 12 weeks of PA monitoring. Methods: Patients were assessed with the 3-question (days/minutes/intensity) physical activity vital sign (PAVS) via their electronic patient portal prior to an office visit. Those who self-reported less than 50% of current PA recommendations prompted a BPA to their cardiologist to counsel them on improving their PA. Patients were then offered participation in remote patient monitoring wearing a Fitbit for 12 weeks. Blood pressure, waist circumference, lipids, BMI, PA (using the PAVS and Fitbit step-counts) and the six-minute walk test (for cardiorespiratory fitness) were measured at baseline and 12 weeks. Paired t -tests assessed for changes in these CVD risk factors from baseline to 12 weeks. We calculated the percent of participants who achieved a clinically important difference of 25 meters in the six-minute walk test. Results: The enrolled sample (n=59) were primarily female (51%), White adults (76%) with a mean age of 61.13±11.6 years. There was significant improvement in moderate-to-vigorous PA as self-reported by the PAVS (43±86 vs. 114±157, p=.005). There was no significant difference between week 2 step counts (baseline) and week 12 (p=.07). There was significant improvement in the distance covered (in meters) during the six-minute walk test (469±108 vs. 494±132, p=.0034) and 23 participants (42%) improved at least 25 meters. There were also significant differences in total cholesterol (163±51 mg/dl at baseline vs. 148±45mg/dl at 12 weeks; p=.0.02). No other improvements in CVD risk factors were noted. Conclusion: Patients who reported low PA and triggered a BPA for PA counseling had improvements in some, but not all, CVD risk factors. Additional counseling may be needed to improve and maintain PA levels in patients at risk of CVD.