Study highlights:
• The majority of family members of patients hospitalized with heart disease are not meeting national standards for preventive care.
• A hospital-based systems approach to screening and counseling family members of cardiac patients resulted in greater benefits in diet and HDL-cholesterol change than controls. 

NEW ORLEANS, La., Nov. 12 — Relatives of hospitalized heart disease patients improved their lifestyle and lowered some risk factors after participating in a hospital-based systems approach to health screening and lifestyle counseling, researchers reported at the American Heart Association’s Scientific Sessions 2008. Results from A Novel Family-based Intervention Trial to Improve Heart Health (FIT Heart): Results of a Randomized Controlled Trial were presented as a late-breaking clinical trial.

“Having a family member hospitalized with an acute cardiovascular event might represent a very unique ‘motivational moment’ in which relatives would be willing to take personal action to improve their own lifestyles and lower their cardiovascular risk,” said Lori Mosca, M.D., Ph.D., M.P.H., study author and professor of medicine at Columbia University Medical Center and director of preventive cardiology at New York-Presbyterian Hospital.

The study, conducted at New York-Presbyterian Hospital/Columbia University Medical Center, followed 501 adult relatives of cardiovascular disease (CVD) patients for one year. Participants were 66 percent female, 36 percent racial/ethnic minorities and their average age was 48 years.

Researchers randomized half of the participants to the control intervention (CI), which received a general handout about risk factor reduction. The other half received a special intervention (SI), beginning with on-the-spot risk factor screening with immediate feedback, plus a year of diet and exercise counseling from bilingual health educators who sent progress reports to physicians. All the participants answered questionnaires about diet and exercise and took cholesterol tests at the beginning and end of the study.

After one year, the researchers saw significant improvements in low-density lipoprotein cholesterol (LDL-C) — a component of total cholesterol associated with an increased risk of CVD — in both groups, with no excess benefit for the intervention group. Mosca said that could indicate just how much witnessing a loved one struggle with and recover from a CVD event can motivate family members to work to improve their own risk factors.

“People in the control group might have been motivated to eat better and lower their cholesterol because they had someone in the hospital with cardiovascular disease,” Mosca said. “Our study looks at the effect of that motivation plus special education on how to improve lifestyle and lower risk. We saw improvements in diet and cholesterol levels in both groups, suggesting that indeed having a family member with a cardiac crisis might stimulate preventive action. But we saw additional benefits in the group that received personalized risk information plus counseling.”

Compared to controls, the intervention group had a greater improvement in diet score, a tool for dietary assessment recommended by the National Cholesterol Education Program and validated previously. Both groups showed significant reductions in the amount of dietary saturated fat, dietary cholesterol and trans fat they consumed, as well as improvements in their physical activity levels. However, intervention subjects were more likely than controls to report exercising at least three days per week, moving toward recommendations in American Heart Association guidelines.

Participants in the SI group had a slight increase in blood levels of high-density lipoprotein cholesterol (HDL-C), a component of total cholesterol that is thought to help protect against heart disease, while those in the CI group had a significant decline in HDL-C levels.

“Health-related behavior is influenced by perceived susceptibility to disease,” Mosca said.

“Researchers and clinicians have known for several years that relatives of cardiovascular disease patients are at increased risk of getting heart and blood vessel disease themselves both because of shared genetics and shared lifestyle factors such as diet and exercise habits.”

But there has never been a systematic approach to identifying and addressing those issues at the time a relative is hospitalized. Usually, the preventive medical care of relatives of patients with heart disease must be initiated on an individual basis, often by the patients’ relatives themselves.

“Although we tested a hospital-based model that systematically offered screening and counseling to family members of cardiac patients, our finding may have implication in other settings,” Mosca said. “We may often miss opportunities in practice, when we see a patient with recent CVD, to inquire about and refer their family members who may be at risk for education.”

While a leave-it-up-to-the-individual approach might miss some relatives who could benefit from screening and lifestyle counseling, a systems approach includes everyone because it looks at all adult family members and gives everyone the benefit of the same quality of preventive care, Mosca said.

“Using health educators to review risk factor screening results and counsel patients about lifestyle may be a very cost-effective approach,” she said, noting that she would also like to see data from this and future studies used to create new national guidelines with the provision of referring for relatives of CVD patients added to other quality of care indicators when patients are discharged from a hospital.

“Our data document that the majority of family members of patients with cardiac disease are not meeting national standards for preventing heart disease,” Mosca said. “This is a missed opportunity because prevention has been shown to account for a substantial portion of the decline in the death rate of heart disease we have enjoyed over the last few decades. We could potentially reach many high risk individuals at a very opportune time to make lifestyle improvements with a systems approach.”

Co-authors are: Heidi Mochari, M.P.H, R.D.; Ming Liao, B.S.; Allison H. Christian, Ed.D.; Dana J. Edelman, M.P.H.; Brooke Aggarwal, Ed.D.; and Mehmet C. Oz, M.D. Individual author disclosures are available on the abstract.

The study was funded by the National Institutes of Health.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www.americanheart.org/corporatefunding. 

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NR08-1166 (LBCT-SS-08/Mosca)
 

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