George C. Faircloth

Effect of Comprehensive Therapeutic Lifestyle Changes on Prehypertension

Although national clinical guidelines promulgate therapeutic lifestyle changes (TLC) as a cornerstone in the management of prehypertension, there is a perceived ineffectiveness of TLC in the real world. In this study of 2,478 ethnically diverse (African Americans n = 448, Caucasians n = 1,881) men (n = 666) and women (n = 1,812) with prehypertension and no known atherosclerotic cardiovascular disease, diabetes mellitus, or chronic kidney disease, we evaluated the clinical effectiveness of TLC in normalizing blood pressure (BP) without antihypertensive medications. Subjects were evaluated at baseline and after an average of 6 months of participation in a community-based program of TLC. TLC included exercise training, nutrition, weight management, stress management, and smoking cessation interventions. Baseline BP (125 +/- 8/79 +/- 3 mm Hg) decreased by 6 +/- 12/3 +/- 3 mm Hg (p <or=0.001), with 952 subjects (38.4%) normalizing their BP (p <or=0.001). In subjects with a baseline systolic BP of 120 to 139 mm Hg (n = 2,082), systolic BP decreased by 7 +/- 12 mm Hg (p <or=0.001). In subjects with a baseline diastolic BP of 80 to 89 mm Hg (n = 1,504), diastolic BP decreased by 6 +/- 3 mm Hg (p <or=0.001). There were no racial differences in the magnitude of reduction in BP; however, women had greater BP reductions than men (p <or=0.001). Also, subjects with a baseline body mass index (BMI) <30 kg/m(2) had a greater reduction in BP than those with a BMI >or=30 kg/m(2). In conclusion, the present study adds to previous research by reporting on the effectiveness, rather than the efficacy, of TLC when administered in a real-world, community-based setting.

Effect of Exercise-Based Cardiac Rehabilitation on Multiple Atherosclerotic Risk Factors in Patients Taking Antidepressant Medication

Antidepressants might increase compliance with cardiovascular disease risk reduction interventions. However, antidepressants have been linked to deleterious metabolic effects. In the present multicenter study, we sought to determine whether patients who take antidepressants derive the expected benefits from cardiac rehabilitation in terms of improvements in multiple atherosclerotic risk factors. A cohort of 26,957 patients who had completed a baseline assessment before participating in an exercise-based cardiac rehabilitation program constituted the study population. The patients were stratified into 3 cohorts (i.e., nondepressed, depressed unmedicated, and depressed medicated) at baseline according to a self-reported history of depression and the current use of antidepressants. Risk factors were assessed at baseline and after ∼12 weeks of program participation. A self-reported history of depression was present at baseline in 5,172 patients (19.2%). Of these patients, 2,147 (41.5%) were taking antidepressants. Patients in the nondepressed cohort (49.4% completion) were more likely (p <0.001) to complete the exit assessment than patients in the depressed unmedicated (44.5% completion) or depressed medicated (43.5% completion) cohorts. Patients in all 3 cohorts who completed the exit assessment showed significant improvement in multiple risk factors. Moreover, the magnitude of improvement in blood pressure, serum lipids and lipoproteins, fasting glucose, weight, and body mass index was similar (p >0.05) in patients taking antidepressants and those who were not. In conclusion, our study is the first to show that antidepressants do not offset the average magnitude of improvement in multiple atherosclerotic risk factors that occurs with completion of a cardiac rehabilitation program.

EVALUATION OF THE CARDIOSMART POPULATION HEALTH MANAGEMENT INITIATIVE: CHANGES IN HEALTH RISKS AND PARTICIPANT SATISFACTION

Background: Rapidly escalating healthcare costs have led to increasing attention on population health management (PHM). CardioSmart (CS) is a patient education and empowerment initiative of the American College of Cardiology that includes worksite wellness (CS@Work) and telehealth (CS OnCall) PHM

Clinical Effectiveness of Lifestyle Health Coaching: Case Study of an Evidence-Based Program

We have developed, tested, and successfully implemented an affordable, evidence-based, technology-enabled, data-driven, outcomes-oriented, comprehensive lifestyle health coaching (LHC) program. The LHC program has been used primarily to provide services to employees of larger employers (ie, with at least 3000 employees) but has also been implemented in a variety of other settings, including hospitals, cardiac rehabilitation centers, physician practices, and as part of multicenter clinical trials. The program is delivered mainly using the telephone and Internet. Health coaches are guided by a Web-based participant management and tracking system. Lifestyle management interventions are based on several behavior change models and strategies, especially adult learning theory, social learning theory, the stages of change model, single concept learning theory, and motivational interviewing. The program is administered by nonphysician health professionals whose services are integrated with the care provided by participants’ physicians. Outcomes data from published studies, including randomized clinical trials and independent third-party conducted research, have documented the clinical effectiveness of this evidence-based approach in terms of modification of multiple risk factors in healthy persons as well as those with certain common chronic diseases.

Multicenter study of temporal trends in the achievement of atherosclerotic cardiovascular disease risk factor goals during cardiac rehabilitation

PURPOSE: Secondary prevention risk factor goals have been established by the American Heart Association/American College of Cardiology, and the American Heart Association has further delineated ideal cardiovascular health metrics. We evaluated risk factor goal achievement during early-outpatient cardiac rehabilitation (CR) and temporal trends in risk factor control. METHODS: Patients completed assessments on entry into and exit from CR at 35 centers between 2000 and 2009 and were categorized into 3 cohorts: entire (N = 12 984), 2000-2004 (n = 5468), and 2005-2009 (n = 7516) cohorts. RESULTS: Improvements occurred in multiple risk factors during CR. For the entire cohort, the percentages of patients at goal at CR completion ranged from 95.5% for smoking to 21.9% for body mass index (BMI) of <25.0 kg/m2. Compared with 2000-2004, the percentage of the 2005-2009 cohort at goal was higher (P < .001) for blood pressure, low-density lipoprotein cholesterol, and physical activity, lower (P = .005) for BMI, and not significantly different (P > .05) for fasting glucose and smoking. At CR completion, of those in the entire, 2000-2004, and 2005-2009 cohorts, 4.4%, 3.9%, and 4.8% (P = .219 vs 2000-2004), respectively, had all biomarkers at the goal for ideal cardiovascular health and, of those with atherosclerotic cardiovascular disease, 70.8%, 71.5%, and 70.3% (P = .165 vs 2000-2004), respectively, were receiving statins. CONCLUSIONS: The percentage of patients at goal at CR completion increased for some, but not all, risk factors during 2005-2009 versus 2000-2004. Despite the benefits of CR, risk factor profiles are often suboptimal after CR. There remains room for improvement in risk factor management during CR and a need for continued intervention thereafter.