CONTEXT: Although the use of electron beam tomography (EBT) as a motivational tool to change behavior is practiced, its efficacy has not been studied. OBJECTIVE: To assess the effects of incorporating EBT as a motivational factor into a cardiovascular screening program in the context of either intensive case management (ICM) or usual care by assessing its impact over 1 year on a composite measure of projected risk. DESIGN: Randomized controlled trial with a 2 x 2 factorial design and 1 year of follow-up. SETTING AND PARTICIPANTS: A consecutive sample of 450 asymptomatic active-duty US Army personnel aged 39 to 45 years stationed within the Washington, DC, area and scheduled to undergo a periodic Army-mandated physical examination were enrolled between January 1999 and March 2001 (mean age, 42 years; 79% male; 66 [15%] had coronary calcification; mean [SD] predicted 10-year coronary risk, 5.85% [3.85%]). INTERVENTIONS: Patients were randomly assigned to 1 of 4 intervention arms: EBT results provided in the setting of either ICM (n = 111) or usual care (n = 119) or EBT results withheld in the setting of either ICM (n = 124) or usual care (n = 96). MAIN OUTCOME MEASURE: The primary outcome measure was change in a composite measure of risk, the 10-year Framingham Risk Score (FRS). RESULTS: Comparing the groups who received EBT results with those who did not, the mean absolute risk change in 10-year FRS was +0.30 vs +0.36 (P =.81). Comparing the groups who received ICM with those who received usual care, the mean absolute risk change in 10-year FRS was -0.06 vs +0.74 (P =.003). Improvement or stabilization of cardiovascular risk was noted in 157 patients (40.2%). In multivariable analyses predicting change in FRS, after controlling for knowledge of coronary calcification, motivation for change, and multiple psychological variables, only the number of risk factors (odds ratio, 1.42; 95% confidence interval, 1.16-1.75 for each additional risk factor) and receipt of ICM (odds ratio, 1.62; 95% confidence interval, 1.04-2.52) were associated with improved or stabilized projected risk. CONCLUSIONS: Using coronary calcification screening to motivate patients to make evidence-based changes in risk factors was not associated with improvement in modifiable cardiovascular risk at 1 year. Case management was superior to usual care in the management of risk factors.
RCT Entities:
CONTEXT: Although the use of electron beam tomography (EBT) as a motivational tool to change behavior is practiced, its efficacy has not been studied. OBJECTIVE: To assess the effects of incorporating EBT as a motivational factor into a cardiovascular screening program in the context of either intensive case management (ICM) or usual care by assessing its impact over 1 year on a composite measure of projected risk. DESIGN: Randomized controlled trial with a 2 x 2 factorial design and 1 year of follow-up. SETTING AND PARTICIPANTS: A consecutive sample of 450 asymptomatic active-duty US Army personnel aged 39 to 45 years stationed within the Washington, DC, area and scheduled to undergo a periodic Army-mandated physical examination were enrolled between January 1999 and March 2001 (mean age, 42 years; 79% male; 66 [15%] had coronary calcification; mean [SD] predicted 10-year coronary risk, 5.85% [3.85%]). INTERVENTIONS:Patients were randomly assigned to 1 of 4 intervention arms: EBT results provided in the setting of either ICM (n = 111) or usual care (n = 119) or EBT results withheld in the setting of either ICM (n = 124) or usual care (n = 96). MAIN OUTCOME MEASURE: The primary outcome measure was change in a composite measure of risk, the 10-year Framingham Risk Score (FRS). RESULTS: Comparing the groups who received EBT results with those who did not, the mean absolute risk change in 10-year FRS was +0.30 vs +0.36 (P =.81). Comparing the groups who received ICM with those who received usual care, the mean absolute risk change in 10-year FRS was -0.06 vs +0.74 (P =.003). Improvement or stabilization of cardiovascular risk was noted in 157 patients (40.2%). In multivariable analyses predicting change in FRS, after controlling for knowledge of coronary calcification, motivation for change, and multiple psychological variables, only the number of risk factors (odds ratio, 1.42; 95% confidence interval, 1.16-1.75 for each additional risk factor) and receipt of ICM (odds ratio, 1.62; 95% confidence interval, 1.04-2.52) were associated with improved or stabilized projected risk. CONCLUSIONS: Using coronary calcification screening to motivate patients to make evidence-based changes in risk factors was not associated with improvement in modifiable cardiovascular risk at 1 year. Case management was superior to usual care in the management of risk factors.
Authors: Nicolas Rodondi; Reto Auer; Vanessa de Bosset Sulzer; William A Ghali; Jacques Cornuz Journal: J Gen Intern Med Date: 2011-09-01 Impact factor: 5.128
Authors: Francesca Mantovani; Sahar S Abdelmoneim; Victoria Zysek; Susan Eifert-Rain; Sharon L Mulvagh Journal: J Womens Health (Larchmt) Date: 2014-06-16 Impact factor: 2.681
Authors: Samir N Patel; Venkataraman Rajaram; Sanjay Pandya; Benjamin M Fiedler; Charlotte J Bai; Rachel Neems; Matt Feinstein; Marshall Goldin; Steven B Feinstein Journal: Curr Atheroscler Rep Date: 2004-01 Impact factor: 5.113