Cardiovascular Disease Prevention Program Research Articles

Abstract P365: Systematic Review of Self-Management Interventions for Black Women With Cardiovascular Risk Factors

Background: Cardiovascular disease (CVD) is the leading cause of death among Black women, and when compared to their non-Hispanic White counterparts, they are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review assessed the efficacy of self-management interventions for Black women with CVD risk factors. Hypothesis: Self-management interventions that target more than one health practice, when administered to Black women with CVD risk factors, will decrease CVD risk and improve clinical outcomes. Methods: Searches were run on PubMed, Cochrane, CINAHL, and PsycINFO databases based on the following inclusion criteria: papers written from September 22, 2018; English language; US studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices (individual or group, in-person or remotely delivered, or person-person synchronous); primary prevention; comorbid conditions without a cardiovascular event; at least one patient level outcome (self-reported or biological); Black women at least 18 years of age only. Data extraction included participant demographics; intervention characteristics; self-management/health behavior domains; research design; and study outcomes. Results: Of the 1041 abstracts screened (262 duplicates removed), 87 full-text articles were screened, and 11 papers from 10 unique trials (N= 1,635) were chosen for inclusion. Intervention durations ranged from 5-weeks to 12-months, with a frequency of intervention dose ranging from daily contact to bi-weekly meetings. Of the 10 unique trials, the majority targeted physical activity (n=8), nutrition (n=5), weight loss (n=3), health knowledge (n=2), and BP control (n=2). Interventions were mostly offered in groups (n=9), and some included individual components (n=2). Nine of the eleven papers reported statistically significant improvements in CVD risk factors including weight loss (n=6), physical activity (n=2), BP control (n=2), waist circumference (n=1), and depression (n=1). Few papers (N=1) addressed mental health, and none addressed other social determinants of health. Conclusions: Evidence to date indicates that self-management interventions are not only feasible but also appear to improve CVD risk factors and clinical outcomes in Black women with CVD risk. Future research should assess best practices for the implementation of culturally informed CVD risk prevention programs in underserved populations. Further intervention development should focus on the influence that social determinants of health such as discrimination, stress, and mental health may have on self-management and CVD risk in this population.

A community health promotion project: Amazing Race for Heart Health.

American Indians have higher rates of cardiovascular disease (CVD), likely due to disproportionate burden of diabetes and limited access to widespread CVD prevention programs such as Honoring the Gift of Heart Health (HGHH), a 10-week CVD risk factor awareness curriculum. Due to its length, HGHH may be difficult to complete; therefore, we aimed to evaluate a shortened CVD risk factor awareness program based on the HGHH educational materials for American Indians residing in southwest Oklahoma, entitled "The Amazing Race for Heart Health." We conducted an interventional study where each participant served as their own control (n = 61), with pre- and post-intervention measurements. We included American Indians from seven tribal nations in southwest Oklahoma. At two interventional meetings we used educational materials and activities from HGHH focusing on nutrition, cholesterol, diabetes, hypertension, physical activity, and heart attack warning signs. McNemar's test was used to determine the effectiveness of the intervention on raising CVD risk factor awareness. When comparing the pre- and post-survey responses, the percentage of correct responses either stayed the same or increased. Knowledge improved in 11/25 (44%, p < 0.05) domains including the difference between good and bad cholesterol and types of physical activity that can prevent CVD. When considering diabetes, knowledge increased regarding the interaction between diabetes and cholesterol in the association with CVD. These results demonstrate that the "Amazing Race for Heart Health," a shortened CVD risk factor educational program based on the HGHH educational materials, was effective at increasing awareness regarding CVD risk factors.

The NHS Health Check programme: a survey of programme delivery in England before and after the Covid-19 pandemic response.

This study investigated NHS Health Check programme delivery before and after the Covid-19 pandemic response, with a focus on support services and referral methods available to Health Check attendees. The NHS Health Check is an important part of England's Cardiovascular Disease (CVD) prevention programme. Public health commissioners from all 151 local authorities responsible for commissioning the NHS Health Check programme were surveyed in 2021, using an online questionnaire to capture detail about programme delivery, changes in delivery because of the pandemic response, and monitoring of programme outcomes. Four-point rating scales were used to obtain level of confidence in capacity, accessibility and usage of follow-on support services for Health Check attendees. A typology of programme delivery was developed, and associations between delivery categories and a range of relevant variables were assessed using one-way analysis of variance. Sixty-eight responses were received on behalf of 74 (of 151) local authorities (49%), across all geographical regions. Our findings suggest a basic typology of delivery, though with considerable variation in who is providing the Checks, where and how, and with continued changes prompted by the Covid-19 pandemic. Support for risk management is highly varied with notable gaps in some areas. Local authorities using a model of delivery that includes community venues tended to have a higher number of services to support behaviour change following the Check, and greater confidence in the accessibility and usage of these services. A minority of local authorities gather data on referrals for Health Check attendees, or on outcomes of referrals. The Covid-19 pandemic has prompted continued changes in delivery, which are likely to influence patient experience and outcomes; these need careful evaluation. The programme's delivery and commissioners' intentions to follow through risk communication with appropriate support is challenged by the complexity of the commissioning landscape.

Cost-effectiveness analysis of implementing polygenic risk score in a workplace cardiovascular disease prevention program.

Polygenic risk score for coronary artery disease (CAD-PRS) improves precision in assessing the risk of cardiovascular diseases and is cost-effective in preventing cardiovascular diseases in a health system and may be cost-effective in other settings and prevention programs such as workplace cardiovascular prevention programs. Workplaces provide a conducitve environment for cardiovascular prevention interventions, but the cost-effectiveness of CAD-PRS in a workplace setting remains unknown. This study examined the cost-effectiveness of integrating CAD-PRS in a workplace cardiovascular disease prevention program compared to the standard cardiovascular workplace program without CAD-PRS and no-workplace prevention program. We developed a cohort simulation model to project health benefits (quality-adjusted life years gained) and costs over a period of 5 years in a cohort of employees with a mean age of 50 years. The model health states reflected the risk of disease (coronary artery disease and ischemic stroke) and statin prevention therapy side effects (diabetes, hemorrhagic stroke, and myopathy). We considered medical and lost productivity costs. Data were obtained from the literature, and the analysis was performed from a self-insured employer perspective with future costs and quality-adjusted life years discounted at 3% annually. Uncertainty in model parameter inputs was assessed using deterministic and probabilistic sensitivity analyses. Three programs were compared: (1) a workplace cardiovascular program that integrated CAD-PRS with the pooled cohort equation-a standard of care for assessing the risk of cardiovascular diseases (CardioriskSCORE); (2) a workplace cardiovascular prevention program without CAD-PRS (Standard-WHP); and (3) no-workplace health program (No-WHP). The main outcomes were total costs (US $2019), incremental costs, incremental quality-adjusted life years, and incremental cost-effectiveness ratio. CardioriskSCORE lowered employer costs ($53 and $575) and improved employee quality-adjusted life years (0.001 and 0.005) per employee screened compared to Standard-WHP and No-WHP, respectively. The effectiveness of statin prevention therapy, employees' baseline cardiovascular risk, the proportion of employees that enrolled in the program, and statin adherence had the largest effect size on the incremental net monetary benefit. However, despite the variation in parameter input values, base case results remained robust. Polygenic testing in a workplace cardiovascular prevention program improves employees' quality of life and simultaneously lowers health costs and productivity monetary loss for employers.

The NHS Health Check programme: a survey of programme delivery in England before and after the Covid-19 pandemic response

Background: This study investigated NHS Health Check programme delivery before and after the Covid-19 pandemic response, with a focus on support services and referral methods available to Health Check attendees. The NHS Health Check is an important part of England’s Cardiovascular Disease (CVD) prevention programme. Methods: Public health commissioners from all 151 local authorities responsible for commissioning the NHS Health Check programme were surveyed in 2021, using an online questionnaire to capture detail about programme delivery, changes in delivery because of the pandemic response, and monitoring of programme outcomes. Four-point rating scales were used to obtain level of confidence in capacity, accessibility and usage of follow-on support services for Health Check attendees. A typology of programme delivery was developed, and associations between delivery categories and a range of relevant variables were assessed using one-way analysis of variance. Results: Sixty-eight responses were received on behalf of 74 local authorities (49%), across all geographical regions. Our findings suggest a basic typology of delivery, though with considerable variation in who is providing the Checks, where and how, and with continued changes prompted by the Covid-19 pandemic. Support for risk management is highly varied with notable gaps in some areas. Local authorities using a model of delivery that includes community venues tended to have a higher number of services to support behaviour change following the Check, and greater confidence in the accessibility and usage of these services. A minority of local authorities gather data on referrals for Health Check attendees, or on outcomes of referrals. Conclusions: The Covid-19 pandemic has prompted key innovations in delivery, which are likely to influence patient experience and outcomes; these need careful evaluation. The programme’s delivery and intention to follow through risk communication with appropriate support is challenged by the complexity of the commissioning landscape.

Evaluating the clinical effectiveness of the NHS Health Check programme: a prospective analysis in the Genetics and Vascular Health Check (GENVASC) study

ObjectiveThe aim of the study was to assess the clinical effectiveness of the national cardiovascular disease (CVD) prevention programme—National Health Service Health Check (NHSHC) in reduction of CVD risk.DesignProspective cohort...

Abstract P108: Post-Diagnosis Body Weight Change and Cardiovascular Outcomes in Cancer Survivors

Background: The development of cancer and its treatment often entail changes in body weight. This study aimed to investigate the association of post-diagnosis body weight change with cardiovascular disease (CVD) risk in cancer survivors. Methods: From the Korean National Health Insurance database, we identified 112,565 3-year cancer survivors who had been diagnosed with cancer at age ≥20 years from 2006 through 2013 and had normal body weight (body mass index [BMI] 18.5-22.9 kg/m2) before a cancer diagnosis. In categorical analysis, participants were classified into 4 groups according to their post-diagnosis BMI: 1) obesity (BMI ≥25 kg/m2); 2) overweight (BMI 23-24.9 kg/m2); 3) normal weight (BMI 18.5-22.9 kg/m2); and 4) underweight (BMI &lt;18.5 kg/m2). In continuous analysis, post-diagnosis change in BMI was assessed by subtracting pre-diagnosis BMI from post-diagnosis BMI. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or cardiovascular death. We examined the association of post-diagnosis BMI change with CVD risk using cause-specific Cox model. Results: Over a median follow-up of 5.5 years, 3,797 new CVD events occurred. The cumulative incidence of CVD according to post-diagnosis BMI was the highest in the obesity group, followed by underweight, overweight, and normal weight groups (Figure A). The findings remained broadly consistent after multivariable adjustment; being obese post-diagnosis was associated with a higher CVD risk than maintaining normal weight (HR 1.28, 95% CI 1.05-1.58). However, being underweight post-diagnosis was no more associated with the risk of CVD (HR 0.99, 95% CI 0.86-1.14) (Figure B). Similar findings were observed in a continuous analysis (Figure C). Conclusions: Weight gain after a cancer diagnosis was associated with a higher CVD risk, whereas the association was null for post-diagnosis weight loss. CVD prevention programs for cancer survivors should consider incorporating strategies for preventing weight gain.

Neighborhood level facilitators and barriers to hypertension management: A Native Hawaiian perspective

Native Hawaiians have a disproportionately high prevalence of hypertension, which is an important and modifiable risk factor for cardiovascular disease (CVD). To reduce CVD among Native Hawaiians, we must better understand facilitators and barriers to hypertension management (i.e., diet, physical activity, stress reduction) unique to Native Hawaiians. Despite evidence of neighborhood-level facilitators and barriers to hypertension management in other populations, there is limited research in Native Hawaiians. Participants from a randomized controlled trial (n = 40) were recruited for 5 focus groups. All participants were self-reported Native Hawaiians and had uncontrolled hypertension. Discussions elicited experiences and perceptions of neighborhood-level stressors as they relate to participants’ hypertension management efforts. Audio recordings were transcribed and analyzed using ATLAS.ti for emergent themes. Five themes were identified: neighborhood description, community resources, neighborhood change, safety, and social connectedness. Novel barriers to hypertension control included loss of culture and loss of respect for elders, change in community feel, and over-development. Facilitators included social cohesion and collective power. These data provide a deeper understanding of how Native Hawaiians experience neighborhood factors and how those factors impact their efforts to improve their diets, physical activity, and stress management. The findings help to inform the development of multilevel CVD prevention programs. Further research is needed to explore the subtheme of social and emotional stress related to neighborhood change and CVD health risk due to cultural and historic trauma references.

Setting Goals to Reduce Cardiovascular Risk: A Retrospective Chart Review of a Pharmacist-Led Initiative in the Workplace

Background: Cardiovascular diseases (CVD) are the second leading cause of death in Canada with many modifiable risk factors. Pharmacists at a Canadian university delivered a novel CVD risk management program, which included goal-setting and medication management. Aim: This study aimed to describe what CVD prevention goals are composed of in a workplace CVD risk reduction program, and how might these goals change over time. Methods: A longitudinal, descriptive qualitative study using a retrospective chart review of clinical care plans for 15 patients enrolled in a CVD prevention program. Data across 6 visits were extracted from charts (n = 5413 words) recorded from May 2019-November 2020 and analyzed using quantitative content analysis and descriptive statistics. Results: Behavioural goals were most popular among patients and were more likely to change over the 12-month follow-up period, compared to health measure goals. Behavioural goals included goals around diet, physical activity (PA), smoking, medication, sleep and alcohol; health measure goals centered on weight measures, blood pressure (BP) and blood lipid levels. The most common behavioural goals set by patients were for diet (n = 11) and PA (n = 9). Over time, goals around PA, medication, alcohol and weight were adapted while others were added (e.g. diet) and some only continued. Patients experienced a number of barriers to their goal(s) which informed how they adapted their goal(s). These included environmental limitations (including COVID-19) and work-related time constraints. Conclusions: This study found CVD goal-setting in the pharmacist-led workplace wellness program was complex and evolved over time, with goals added and/or adapted. More detailed qualitative research could provide further insights into the patient-provider goal-setting experience in workplace CVD prevention.

Preliminary study of perceived cardiovascular disease risk and risk status of adults in small rural and urban locations in Ibadan, Nigeria.

The burden of cardiovascular disease (CVD) has been on the rise in developing countries like Nigeria recently. Studies on perceived CVD risk and the risk status of adults in Ibadan are not readily available, hence this study. A mixed-method design involving a cross-sectional survey and an exploratory qualitative study was utilized. Convenience sampling was used to recruit 418 participants (209 from rural and 209 from urban) for the cross-sectional survey, while purposive sampling was used to recruit 14 participants for the qualitative aspect. The INTERHEART risk score and the Perception of Risk of Heart Disease Scale were used to investigate participants' CVD risk status and perceived risk, respectively. The data from the cross-sectional survey were summarized by using descriptive statistics, and the data were then analyzed by using the chi-square test of association and a multiple logistic regression model, while content thematic analysis was used to analyze the qualitative data. In the rural and urban areas, respectively, 39.7% and 52.2% had a positive perception of CVD risk. In the rural and urban areas, 44% and 41.6% of individuals respectively had moderate-to-high risk of CVD. Participants with at least secondary school education [2.66 (0.61-11.53)] and participants in the urban area [2.62 (0.78-7.08)] had twice higher odds of positive CVD risk perception. Males [3.91 (1.58-9.68)], adults aged 40 and above [1.59 (0.63-4.00)] and urban dwellers [1.21 (0.33-4.39)] had higher odds of a high CVD risk status. The qualitative aspect of the study corroborated the findings from the survey, as many participants did not perceive themselves as being at risk of CVD. The majority of the participants in this study were found to have a moderate-to-high risk of CVD, and many had a negative perception of their risk. Health education and CVD prevention programs are required to curb the burden of CVD.

PS-C10-2: POTENTIAL IMPACT OF THE 2017 AMERICA COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION HIGH BLOOD PRESSURE GUIDELINES ON SECONDARY PREVENTION POPULATION

Objective: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines for adults have redefined blood pressure (BP) thresholds for diagnosis and treatment initiation as well as BP goals. We wanted to explore the potential impact of these recommendations on the prevalence of uncontrolled hypertension and target achievement in a secondary prevention population receiving anti-hypertensive treatment in line with the previous Guidelines. Design &amp; Methods: This was a retrospective study in ambulatory patients attending a secondary cardiovascular disease prevention programme(mean age 62 ± 14, 77% male)using prospectively collected data from electronic medical records (Apollo Lx). Data analysed using JMP, version 7.1(SAS for Windows). Hypertension and target achieved were classified on the basis of previous International (BP &lt; 140/90 mm Hg) as well as the new ACC/AHA Guidelines (BP &lt; 130/80 mm Hg). Results were analysed using JMP Version 7.1(SAS for Windows). Results: Applying the new ACC/AHA cut-offs for BP, the proportion of patients with high normal BP decreased from 63% to 28% (p &lt; 0.001), which translated into an increase in the prevalence of Stage I (39% vs. 15%, p &lt; 0.0001) and Stage II hypertension (14.7% vs. 0.9%, p &lt; 0.001). Overall, BP target was achieved in 75% of the patients using the old definition, compared with 43% with the new ACC/AHA Guidelines. Using the old definition, men were more likely to achieve target BP (78% vs. 72%, P &lt; 0.0001) than women; however with the new cut-offs, BP target achieved was similar in men(42.8%) and women(43%). Using the old definition, some 84% of diabetics achieved BP control, decreasing to 52%with the new Guidelines. 71% of patients with renal impairment had BP targets achieved using the previous definition, compared with 41% in line with the new Guidelines. Conclusions: Compared with the previous European, British and American Guidelines, the new 2017 ACC/AHA recommendations resulted in a substantial increase in the prevalence of uncontrolled hypertension and reduction in patients achieving BP targets in our population. If taken up, these recommendations carry significant implications of increase in the number of anti-hypertensive drug prescribing, issues like polypharmacy, non-adherence and adverse drugs effects, with resultant escalation in health care costs.

Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR.

Our aim was to evaluate the implementation process of a comprehensive cardiovascular disease prevention program in general practice, to enhance understanding of influencing factors to implementation success and sustainability, and to learn how to overcome barriers. Cardiovascular disease and its risk factors are the world's leading cause of mortality, yet can be prevented by addressing unhealthy lifestyle behavior. Nevertheless, the transition toward a prevention-oriented primary health care remains limited. A better understanding of factors facilitating or hindering implementation success and sustainability of prevention programs, and how barriers may be addressed, is needed. This work is part of Horizon 2020 project 'SPICES', which aims to implement validated preventive interventions in vulnerable populations. We conducted a qualitative process evaluation with participatory action research approach of implementation in five general practices. Data were collected through 38 semi-structured individual and small group interviews with seven physicians, 11 nurses, one manager and one nursing assistant, conducted before, during, and after the implementation period. We applied adaptive framework analysis guided by RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) and Consolidated Framework for Implementation Research (CFIR). Multiple facilitators and barriers affected reach of vulnerable target populations: adoption by primary health care providers, implementation and fidelity and intention to maintain the program into routine practice. In addition, our study revealed concrete actions, linked to implementation strategies, that can be undertaken to address identified barriers. Prioritization of prevention in general practice vision, ownership, and shared responsibility of all team members, compatibility with existing work processes and systems, expanding nurse's roles and upskilling competence profiles, supportive financial and regulatory frameworks, and a strong community - health care link are crucial to increase implementation success and long-term maintenance of prevention programs. COVID-19 was a major barrier to the implementation. RE-AIM QuEST, CFIR, and participatory strategies are useful to guide implementation of prevention programs in primary health care.

Cardiovascular disease risk factors in the Lubelskie Voivodeship in 2008-2018 - part II: the obesity epidemic

Introduction: All over the world, the problem of excess body weight is being raised more and more frequently. In 2021. the number of obese people has tripled compared to 1975. Due to the constantly growing number of people meeting the criteria for overweight and obesity, it is becoming extremely important to implement preventive measures. Cardiovascular Diseases Prevention Program implemented in Poland as part of the National Health Fund program is a good opportunity to identify patients with abnormal body weight and to correct behavior and health education.&#x0D; Material: A retrospective analysis of data obtained by the National Health Fund as part of the implementation of 86,485 preventive cards of the Cardiovascular Diseases Prevention Program in the Lubelskie Voivodeship in 2008-2018 was carried out. The analyzes were performed using the IBM SPSS Statistics for Windows, version 25 program. The chi-square test and the Pearson linear correlation between the quantitative features were used to test the relationship between the two qualitative features. Significant predictors of a risk factor for cardiovascular disease were determined using multivariate logistic regression. The significance level was assumed to be α = 0.05 for two-tailed tests.&#x0D; Results: The average BMI value was 26.12 kg / m2. 1st degree obesity was diagnosed in 14.3% of patients, 2nd degree - 2.9%, 3rd degree - 0.7%. Excess body weight was significantly more often observed among men. With the increase in the number of years in the study population, the occurrence of overweight and obesity was significantly higher. One unit increase in BMI was associated with a 13% increase in the risk of high blood pressure and a 12% increase in the risk of serum glucose ≥126 mg/dl. It also increased the risk of hypercholesterolaemia by 4.2% and of elevated LDL levels by 5.5%.&#x0D; Conclusions: The prevalence of obesity is extremely worrying. Excessive body weight undeniably translates into worse health of the population. The Cardiovascular Diseases Prevention Program at Primary Healthcare Clinics is a convenient opportunity to identify the factors leading to the development of obesity and to promote health-promoting behaviors.

Cardiovascular disease risk factors in the Lubelskie Voivodeship in 2008-2018 - part I: tobacco smoking

Background: Smoking is one of the most common cardiovascular risk factors. It is responsible for 7 million deaths annually in the world. Another 1.2 million people die from passive smoking. Nicotinism causes a chronic inflammatory process, oxidative stress, and it also works by increasing adrenergic arousal. The Cardiovascular Diseases Prevention Program implemented by Primary Healthcare Clinics is designed to assess the risk factors for cardiovascular events in patients. This provides an opportunity for an early response and appropriate action.&#x0D; Methods: A retrospective analysis of data obtained by the National Health Fund as part of the implementation of 86,485 preventive cards of the Cardiovascular Diseases Prevention Program in the Lubelskie Voivodeship in 2008-2018 was carried out. The analyzes were performed using the IBM SPSS Statistics for Windows, version 25 program. The chi-square test and the Pearson linear correlation between the quantitative features were used to test the relationship between the two qualitative features. Significant predictors of a risk factor for cardiovascular disease were determined using multivariate logistic regression. The significance level was assumed to be α = 0.05 for two-tailed tests.&#x0D; Results: Tobacco smoking was declared by 26.5% of all respondents. It was significantly more often declared by men. The percentage of smokers increased with age - the highest was obtained for the group of 55-year-olds. Smoking cigarettes was significantly more often reported by people with primary education (44%), manual workers (33%) and retirees / pensioners (35%). Smoking tobacco escalated the risk of being diagnosed with arterial hypertension by 16.5%. It significantly influenced the risk of diabetes - even by 33.9%. It raised the risk of hypercholesterolaemia by 17.1% compared to never-smokers as well.&#x0D; Conclusions: The prevalence of nicotinism is alarmingly high. The effective implementation of the Cardiovascular Diseases Prevention Program provides an opportunity to educate on a large scale and identify patients at high risk of a cardiovascular event. Assessing the risk of death on the SCORE scale can motivate patients to change their lifestyle and make them aware of the impact of smoking on increasing this risk.

Association between hair steroid hormone levels and cardiometabolic risk factors in a group of women participating in the national CVD prevention program: A cross-sectional study

Background and Aims : Cardiovascular disease (CVD) is the major cause of death worldwide. Although women develop CVD later than men, women’s morbidity and mortality from CVD are similar compared with men. Such a high prevalence of CVD cannot be explained completely by conventional risk factors. Recent studies indicate that chronic stress may be an independent CVD risk factor. Thus, we aimed to investigate the relationship between the biomarkers of chronic stress (hair cortisol, cortisone, DHEA levels) and traditional cardiovascular risk factors, as well as Systematic COronary Risk Evaluation (SCORE2) index, in a group of women (50-64 years) participating in the national CVD prevention program.

Tackling cardiovascular prevention after coronary disease settled: the challenges of guideline implementation

Funding AcknowledgementsType of funding sources: None.PurposeCardiovascular disease (CVD) as it is known, is a multifactorial disease that needs to be addressed exactly in that way. Knowledge deficit regarding symptoms and unadjusted lifestyles are still the most relevant nursing diagnoses identified as main causes for readmissions in patients with CVD (1). Recent guidelines evidenced that after a CVD event, patients should attend to their lifestyle choices and health behaviors, in order to avoid future events, as this works in a cardioprotective way (2). Having programs structured in a way that makes it possible to involve both population and person-centered strategies all teamed up, could be a way of involving patients in their own care, tackling several recommendations at the same time. Our aim is to describe the implementation of a cardiovascular disease prevention program with a multidisciplinary approach and identify the most prevalent CVD risk factors during the first trimester of its implementation.MethodsIn order to improve patient outcomes post-discharge, the program was outlined as follows: firstly. a Multidisciplinary Appointment was structured, with a Cardiologist and a Nurse, where also family is invited, to assess risk factors, therapeutic adherence and quality of life. According to the patient's needs and preferences they can be assigned to the Cardiac Rehabilitation Lab, to the Education Group Sessions on CVD risk factors where a Nutritionist, Psychiatrist and Physiatrist also participate according to the sessions' topic. For more personalized approach it also comprises: Therapeutic Groups and Mental Health Appointment; Nutrition Appointment; and Nursing Counseling at Outpatient clinics for family and person-centered approach. To assess the program at its third month baseline the focus group method was used for patients and professionals perspectives.ResultsThe program was implemented from October to December 2021. During that time 24 patients were admitted. Nursing Counseling was needed for almost all patients for different reasons. Out of those, 50% were assigned to the group sessions, 33.33% were assigned to the Cardiac Rehab, 12.5% were oriented to the Nutrition consults and 20,83% to the Mental Health consults. Even though we offered therapeutic groups as an option for some patients, none of them were willing to go. Regarding the modifiable risk factors, 70% of patients had 3 or more risk factors, showing that we do have a high risk population to tackle. Putting it into perspective, the most prevalent risk factors were dyslipidemia (70.83%), tobacco use (70.83%), obesity (54.17%) and hypertension (50%).ConclusionsManaging a multidisciplinary program can be demanding, and there were several challenges to this program’s implementation such as: short-staffing, structural issues, covid-19 prevention issues, digital systems, agendas, etc.). But focusing on patients' needs and preferences, helped us to do our utmost to make this program happen.

Tailoring lipid management interventions to reduce inequalities in cardiovascular disease risk management in primary care for deprived communities in Northern England: a mixed-methods intervention development protocol

IntroductionHyperlipidaemia contributes a significant proportion of modifiable cardiovascular disease (CVD) risk, which is a condition that disproportionally affects disadvantaged socioeconomic communities, with death rates in the most deprived areas being...

Comprehensive Care after Myocardial Infarction (CCMI): Long-Term Investment in the Health of Polish Citizens.

The comprehensive care model after myocardial infarction (CCMI, in Polish: KOS-Zawał) has been in effect continuously since October 2017. Within the bundle of services financed by the Polish National Health Fund (NHF), patients receive a diagnosis, conservative and invasive treatment, early cardiac rehabilitation and follow-up visits for 12 months. The existing model of managing patients after myocardial infarction (MI) implements all crucial aspects of care recommended by the European Society of Cardiology (ESC), emphasised many times. The purpose of this paper was to report and describe the course of the implementation of the unique concept—CCMI model, including the scope of the introduced changes and the implementation and structural evaluation of its effects over the period 2017–2021. Our preliminary study reported that the CCMI programme reduces the risk of patient death in the first year after MI by 29%. Furthermore, the authors point out the strict cause and effect relationship between the cardiovascular disease prevention programme since 2004 as the key instrument for the primary systemic prevention implemented outside the CCMI model.

Families' expectations of an eHealth family-based cardiovascular disease-risk reduction programme.

Research has shown that families' participation in a cardiovascular disease (CVD) prevention programme could boost early adoption of healthy lifestyle behaviours in families. Behaviour-based, eHealth interventions are a potential means of achieving this. This study aimed to explore expectations of families-parents and children-at risk of CVD towards the design and functionality of an eHealth family-based CVD-risk reduction programme 'Health-e-Hearts'. Three online focus groups were conducted with six families comprising at least one parent at risk of CVD and at least one child aged 5-17 years. The focus groups were video and audio recorded and transcribed. Content analysis was used to synthesize and identify key categories and subcategories regarding development of and engagement with an eHealth programme. Three categories emerged: experiences of health apps and devices; eHealth application needs of family members; and motivators for using an eHealth programme. Experiences included using health apps individually and inconsistently. Needs included personalization, free and easy-to-use, time efficient, and multiple content formats. Motivators for engaging with the programme included goal setting, rewards, and competition. Families' expectations of an eHealth family-based CVD-risk reduction programme include the incorporation of personalized, easy-to-use design features and motivators for engaging with the programme. Family involvement in the development of an eHealth programme such as 'Health-e-Hearts' has the potential to boost early adoption of healthy lifestyle behaviours among all family members.

1094-P: Awareness of Cardiovascular Disease Risk in People with Type 2 Diabetes

Objective: Independent of other risk factors, type 2 diabetes (T2D) increases the risk of heart attack or stroke two-to-threefold and the risk of death twofold. Poorly managed diabetes and commonly comorbid conditions such as hypertension and hyperlipidemia multiply this risk. This cross-sectional study investigates differences in cardiovascular disease (CVD) risk awareness in a sample of people with T2D. Methods: Participants with T2D paying for a subscription to One Drop for diabetes management completed a survey on their health. Three groups were identified: those who did not know their CVD risk, those who reported no risk, and those who reported being at risk for CVD. One-way ANOVA and chi-square tests compared groups on CVD risk factors (comorbidities, health behaviors, A1C, BMI) , self-care knowledge and interest in knowing more about risk. Results: Of the 165 participants, 20.6% did not know their risk, 32.7% indicated no risk and 46.7% indicated they were at risk for CVD. The unknown risk group had the most interest in knowing more about their CVD risk (81.3%; p&amp;lt;.001) and the least engagement in diabetes self-care behaviors (p’s&amp;lt;.05) . The group self-reporting no risk had the lowest rates of hypertension (44% vs. 60%+, p&amp;lt;.02) and hyperlipidemia (26% vs. 50%+, p&amp;lt;.001) , the least knowledge of diabetes self-care behaviors (p=.004) , and the least interest in learning more about their CVD risk (34%; p&amp;lt;.001) . The group self-reporting risk had moderate interest in learning more about their risk (58%) . Groups did not differ on self-reported A1C (p=.23) or BMI (p=.18) . Discussion: Over half of the sample reported unknown or no risk for CVD. Those who did not know their risk had high interest in knowing more about their risk but low engagement in risk-mitigating behaviors. Those reporting no risk had lower rates of comorbidities; however, there was no difference in diabetes-related risk factors between groups. These findings suggest that CVD prevention programs should be developed to complement diabetes-focused programs. Disclosure S.D.Imrisek: Employee; One Drop. J.R.Hoy-rosas: None. L.M.Lavaysse: Employee; One Drop. M.Lee: Employee; One Drop. J.Dachis: Board Member; One Drop, Employee; One Drop, Stock/Shareholder; One Drop. L.Sears: Employee; One Drop.