A Randomized Clinical Trial of Secondary Prevention Among Women Hospitalized with Coronary Heart Disease

Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
Journal of Women's Health (Impact Factor: 2.05). 02/2010; 19(2):195-202. DOI: 10.1089/jwh.2009.1481
Source: PubMed


Secondary prevention improves survival, yet implementation is suboptimal. We tested the impact of a systematic hospital-based educational intervention vs. usual care to improve rates of adherence to secondary prevention guidelines among women hospitalized with coronary heart disease (CHD), according to their ethnic status.
Women (n = 304, 52% minorities) hospitalized with CHD were randomly assigned to a systematic secondary prevention educational intervention vs. usual care. Adherence to goals for smoking cessation, weight management, physical activity, blood pressure <140/90 mm Hg, low-density lipoprotein cholesterol (LDL-C) <100 mg/dL (2.59 mmol/L), and use of aspirin/anticoagulants, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors were assessed at 6 months.
On admission, minority women were less likely than white women to meet the goals for blood pressure (OR = 0.46, 95% CI 0.26-0.80), LDL-C (OR = 0.57, CI 0.33-0.94), and weight management (OR = 0.40, 95% CI 0.20-0.82). There was no difference between the intervention and usual care groups in a summary score of goals met at study completion; however, minority women in the intervention group were 2.4 times more likely (95% CI 1.13-5.03) to reach the blood pressure goal at 6 months compared with minority women in usual care. White women in the intervention group were 2.86 times more likely (95% CI 1.06-7.68) to report use of beta-blockers at 6 months compared with white women in usual care. In a logistic regression model, the interaction term for ethnic status and group assignment was significant for achieving the blood pressure goal (p = 0.009).
A healthcare systems approach to educate women about secondary prevention and blood pressure control may differentially benefit ethnic minority women compared with white women.


Available from: Sidney Smith, May 14, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Women with heart disease have adverse psychosocial profiles and poor attendance in cardiac rehabilitation (CR) programs. Few studies examine CR programs tailored for women for improving their quality of life (QOL). This randomized clinical trial (RCT) compared QOL among women in a traditional CR program with that of women completing a tailored program that included motivational interviewing guided by the Transtheoretical Model (TTM) of behavior change. Two measures of QOL, the Multiple Discrepancies Theory questionnaire (MDT) and the Self-Anchoring Striving Scale (SASS), were administered to 225 women at baseline, postintervention, and 6-month follow-up. Analysis of Variance (ANOVA) was used to compare changes in QOL scores over time. Baseline MDT and SASS scores were 35.1 and 35.5 and 7.1 and 7.0 for the tailored and traditional CR groups, respectively. Postintervention, MDT and SASS scores increased to 37.9 and 7.9, respectively, for the tailored group compared with 35.9 and 7.1 for the traditional group. Follow-up scores were 37.7 and 7.6 for the tailored group and 35.7 and 7.1 for the traditional group. Significant group by time interactions were found. Subsequent tests revealed that MDT and SASS scores for the traditional group did not differ over time. The tailored group showed significantly increased MDT and SASS scores from baseline to posttest, and despite slight attenuation from posttest to 6-month follow-up, MDT and SASS scores remained higher than baseline. The CR program tailored for women significantly improved global QOL compared with traditional CR. Future studies should explore the mechanisms by which such programs affect QOL.
    Journal of Women's Health 11/2010; 19(11):1977-85. DOI:10.1089/jwh.2010.1937 · 2.05 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Coronary heart disease (CHD) includes chest pain, heart attacks, and the need for heart surgery and is a major cause of premature death and disability. Education is a common element of care for people with CHD aiming to decrease mortality and morbidity as well as improving quality of life. This review shows that there is not enough information available to fully understand the impact of educational interventions on mortality, morbidity and health-related quality of life of patients with CHD. Nevertheless, our findings broadly support current guidelines that people with CHD should receive comprehensive rehabilitation that includes education. Further research is needed to evaluate the most clinically and cost-effective ways of providing patient education on CHD.
    Cochrane database of systematic reviews (Online) 12/2011; 12(12):CD008895. DOI:10.1002/14651858.CD008895.pub2 · 6.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Smoking contributes to many health problems including cancers, cardiovascular disease and lung diseases. Smoking also increases the risk associated with hospitalisation for surgery. People who are in hospital because of a smoking-related illness are likely to be more receptive to help to give up smoking. Our review of fifty trials found that effective programmes to stop smoking are those that begin during a hospital stay and include counselling with follow-up support for at least one month after discharge. Such programmes are effective when administered to all hospitalised smokers, regardless of the reason why they were admitted to hospital, and in the subset of smokers who are admitted to hospital with cardiovascular disease. Adding nicotine replacement therapy to a counselling program increases the success rate of a program for hospitalised smokers.
    Cochrane database of systematic reviews (Online) 05/2012; 5(5):CD001837. DOI:10.1002/14651858.CD001837.pub3 · 6.03 Impact Factor
Show more