Chest Pain Observation Unit Risk Reduction Trial
This trial is active, not recruiting.
|Treatments||enhanced counseling, minimal counseling|
|Sponsor||University of Iowa|
|Collaborator||American Heart Association|
|Start date||September 2007|
|End date||September 2009|
|Trial size||240 participants|
|Trial identifier||NCT00536224, 0750112Z|
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.
|Endpoint classification||efficacy study|
|Intervention model||parallel assignment|
|Masking||single blind (outcomes assessor)|
Stage of change for cardiovascular risk-related behaviors (diet, exercise, and smoking)
time frame: 2- and 6-months
Self-reported cardiovascular health behaviors (diet, physical activity, and smoking cessation)
time frame: 2- and 6-months
Male or female participants at least 30 years old.
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)
|Official title||Brief Intervention to Promote Cardiovascular Risk Reduction in Patients Admitted to Chest Pain Observation Units|
|Principal investigator||David A Katz, MD, MSc|
|Description||Increasingly, emergency department patients for whom a non-ischemic etiology of 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. Both adjusted and unadjusted multivariable analyses will be performed to determine the intervention effect (using an intention-to-treat approach). We will also use mediation analysis to evaluate the extent to which the intervention is mediated by HBM constructs (e.g., perceived susceptibility to cardiovascular adverse events, perceived benefit of risk reduction, perceived barriers, self-efficacy). 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.|
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