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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1045 — The Self-Management Addressing Heart Risk Trial (SMAHRT): Baseline Results of an Integrated Health Behavior-Chronic Care Model

Kilbourne AM (VA Ann Arbor HSR&D COE), Goodrich D (VA Ann Arbor HSR&D COE), Burghardt AR (VA Ann Arbor HSR&D COE), Chermack S (VA Ann Arbor HSR&D COE), Bialy D (VA Ann Arbor HSR&D COE), Post EP (VA Ann Arbor HSR&D COE), Schumacher K (VA Ann Arbor HSR&D COE), Bramlet M (VA Ann Arbor HSR&D COE), Lai Z (VA Ann Arbor HSR&D COE), Bauer MS (VA Boston COE)

Objectives:
Persons with mental disorders experience a disproportionate burden of medical comorbidity, notably cardiovascular disease (CVD), leading to premature mortality. CVD risk factors in persons with mental disorders are multifactorial and include unhealthy lifestyles exacerbated by mental health-related symptoms, medication side effects (e.g., weight gain), and the fragmentation of physical and mental health services. Bipolar disorder is a common chronic mental disorder (up to 6% prevalence), and the alternating depressive and manic episodes can uniquely contribute to increased CVD risk. We determined the association between bipolar symptoms and CVD risk factors using baseline findings from the Self-Management Addressing Heart Risk Trial (SMAHRT), a randomized controlled trial determining whether an integrated health behavior-chronic care model (B-CCM) leads to improved physical and mental health outcomes for Veterans with bipolar disorder.

Methods:
Veterans with bipolar disorder and > = 1 CVD risk factors were recruited from the VA Ann Arbor primary and specialty care clinics, and randomized to B-CCM or attention control. The B-CCM included self-management (four 2-hour psychosocial sessions plus regular phone contacts on behavior change in the context of symptom management), phone-based medical care management, and provider guideline dissemination. Baseline and outcomes measures included CVD risk factors (Framingham Risk Score), psychiatric symptoms (Internal State Scale-ISS), and health behaviors.

Results:
Baseline results (N = 118; mean = 54, 17% female) indicate that 84% had hyperlipidemia, 70% had hypertension, and 25% had diabetes. The majority (59%) had a Framingham score > = 20%, indicating moderate to high 10-year risk of CVD. Higher ISS depression scores were associated with 1.67 higher odds of CVD risk based on the Framingham score (OR = 2.67;p = .05), yet higher manic scores were associated with lower Framingham risk scores (OR = .38; p = .02).

Implications:
Depressive symptoms were associated with greater relative 10-year risk for CVD mortality, while greater manic symptoms were associated with a lower CVD mortality risk.

Impacts:
Substantial CVD comorbidity was found among Veterans diagnosed with bipolar disorder. Further research is needed on the CVD-related risk and resilience factors associated with psychiatric symptoms to inform further integration of health behavior change strategies in mental health. B-CCM may potentially address multiple CVD risk factors and could be easily disseminated in VA as part of the emerging Patient-Aligned Care Team and Behavioral Medicine Initiatives.


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