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RRP 09-226 – HSR&D Study

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RRP 09-226
Cross-QUERI Prevention Intervention Project: Planning Meeting
Hayden B Bosworth PhD
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: August 2009 - July 2010

BACKGROUND/RATIONALE:
Cardiovascular risk is a composite measure of several modifiable and non-modifiable risk factors. Diabetes, hypertension, dyslipidemia, and tobacco use are all elements of validated cardiovascular (CVD) risk measures, they are common in the veteran population, and, when controlled or improved, patient's overall CVD risk can decrease. Patients with co-occurrence of any of these risk factors have a markedly increased risk of CVD events. [1] Sedentary lifestyles, diets containing higher levels of salt and saturated fats, and the accompanying rise of obesity and metabolic syndrome, is a pressing concern that will likely continue to increase rates of hypertension, dyslipidemia, diabetes, and CVD. The consequences of this anticipated increase in CVD are enormous. Despite this impact and in spite of the availability of effective therapy for diabetes, hypertension, and dyslipidemia, in the Veterans Health Administration (VHA), only 13% of patients with known CVD achieve target blood pressure (BP) and cholesterol control.[2]

OBJECTIVE(S):
We brought together research and clinical leaders from the following five QUERIs: Diabetes, Stroke, Ischemic heart disease, Heart failure, and Implementation as well as clinical leaders from the VA to develop, eventually evaluate and disseminate, a multi-component intervention focusing on reducing weight, alcohol use as well improving physical activity, medication adherence, smoking cessation, and healthy dietary patterns amongst Veterans.

METHODS:
We are developing a prospective, randomized trial to compare medical outcomes, medical processes, and medical costs among veterans at high risk for cardiovascular events who receive either a multi-component intervention or usual care. The intervention will include multidisciplinary care team (nurses and pharmacists) focusing on medication management and patient self-management with relevant health behaviors. The intervention will reduce not only secondary outcomes such as blood pressure, hemoglobin a1c, low density lipoprotein cholesterol, weight, but also reduce strokes, TIAs, myocardial infarctions, hospitalizations, and mortality.

The specific aims of this project are:

a.To determine whether the intervention program decreases all-cause events among veterans at high risk (prior event or uncontrolled hypertension, LDL, and/or a1c).

b.To determine whether the intervention program improves secondary outcomes (e.g., blood pressure, a1c, LDL, smoking cessation) among veterans at high risk.

c.To determine whether the intervention program improves guideline adherence among clinicians who provide care to veterans at high risk for vascular events.

d.To determine whether the intervention program decreases total medical costs (business case).

e.To determine whether the intervention program is sustainable.

FINDINGS/RESULTS:
No findings to report at this time.

IMPACT:
There are no impacts to report at this time.

PUBLICATIONS:
None at this time.


DRA: none
DRE: Treatment - Observational, Prevention
Keywords: Hypertension, Prevention
MeSH Terms: none

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