BACKGROUND: 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. METHODS: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 mmHg, 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. RESULTS: 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). CONCLUSIONS: A healthcare systems approach to educate women about secondary prevention and blood pressure control may differentially benefit ethnic minority women compared with white women.
RCT Entities:
BACKGROUND: 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. METHODS: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. RESULTS: 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). CONCLUSIONS: A healthcare systems approach to educate women about secondary prevention and blood pressure control may differentially benefit ethnic minority women compared with white women.
Authors: S C Smith; S N Blair; R O Bonow; L M Brass; M D Cerqueira; K Dracup; V Fuster; A Gotto; S M Grundy; N H Miller; A Jacobs; D Jones; R M Krauss; L Mosca; I Ockene; R C Pasternak; T Pearson; M A Pfeffer; R D Starke; K A Taubert Journal: Circulation Date: 2001-09-25 Impact factor: 29.690
Authors: Lori Mosca; Carole L Banka; Emelia J Benjamin; Kathy Berra; Cheryl Bushnell; Rowena J Dolor; Theodore G Ganiats; Antoinette S Gomes; Heather L Gornik; Clarissa Gracia; Martha Gulati; Constance K Haan; Debra R Judelson; Nora Keenan; Ellie Kelepouris; Erin D Michos; L Kristin Newby; Suzanne Oparil; Pamela Ouyang; Mehmet C Oz; Diana Petitti; Vivian W Pinn; Rita F Redberg; Rosalyn Scott; Katherine Sherif; Sidney C Smith; George Sopko; Robin H Steinhorn; Neil J Stone; Kathryn A Taubert; Barbara A Todd; Elaine Urbina; Nanette K Wenger Journal: Circulation Date: 2007-02-19 Impact factor: 29.690
Authors: Rajendra H Mehta; Cecelia K Montoye; Meg Gallogly; Patricia Baker; Angela Blount; Jessica Faul; Canopy Roychoudhury; Steven Borzak; Susan Fox; Mary Franklin; Marge Freundl; Eva Kline-Rogers; Thomas LaLonde; Michele Orza; Robert Parrish; Martha Satwicz; Mary Jo Smith; Paul Sobotka; Stuart Winston; Arthur A Riba; Kim A Eagle Journal: JAMA Date: 2002-03-13 Impact factor: 56.272
Authors: R Cooper; J Cutler; P Desvigne-Nickens; S P Fortmann; L Friedman; R Havlik; G Hogelin; J Marler; P McGovern; G Morosco; L Mosca; T Pearson; J Stamler; D Stryer; T Thom Journal: Circulation Date: 2000-12-19 Impact factor: 29.690