Investigation of Motivational Interviewing and Prevention Consults to Achieve Cardiovascular Targets (IMPACT) trial

Abstract

BackgroundPatients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation. MethodsA prospective, randomized, pilot study was conducted in 400 patients undergoing a nonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies. Patients were randomized in a 1:1:1 fashion to usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC; group B, n = 130), or PC plus behavioral intervention program (telephone-based motivational interviewing and optional tailored text messages) (group C, n = 133). The primary end point was the Δ change in non–high-density lipoprotein cholesterol (non–HDL-C) from baseline to 6 month. ResultsThe mean age was 64.6 ± 10.8 years, 23.7% were female, and 31.5% were nonwhite. After 6 months, the absolute difference in non–HDL-C for all participants was −19.8 mg/dL (95% CI −24.1 to −15.6, P < .001). There were no between-group differences in the primary end point for the combined PC groups (B and C) versus UC, with a Δ adjusted between group difference of −5.5 mg/dL (95% CI −13.1 to 2.1, P = .16). Patients in the PC groups were more likely to be on high-intensity statins at 6 months (52.9% vs 38.1%, P = .01). After excluding participants with baseline non–HDL-C <100 mg/dL (initial exclusion criterion), Δ non–HDL-C and Δ low-density lipoprotein cholesterol were improved in the PC groups compared to UC (non–HDL-C −8.13 mg/dL [−16.00 to −0.27], P = .04; low-density lipoprotein cholesterol −7.87mg/dL [−15.10 to −0.64], P = .03). ConclusionsAlthough non–HDL-C reduction at 6 months following a nonurgent CV procedure was not significant in the overall cohort, an increased uptake in high-potency statins may translate into improved long-term health outcomes and cost reductions.