Effectiveness of letters to patients with or without Cochrane blogshots on 10-year cardiovascular risk change among women in menopausal transition: 6-month three-arm randomized controlled trial

Slavica Jurić Petričević, Ivan Buljan, Dora Bjelanović, Nataša Mrduljaš-Đujić, Tanja Pekez, Mario Ćurković, Željko Vojvodić, Ivančica Pavličević, Matko Marušić, Ana Marušić, Slavica Jurić Petričević, Ivan Buljan, Dora Bjelanović, Nataša Mrduljaš-Đujić, Tanja Pekez, Mario Ćurković, Željko Vojvodić, Ivančica Pavličević, Matko Marušić, Ana Marušić

Abstract

Background: Health information and patient education on lifestyle changes may have a positive effect on the prevention of many chronic conditions, especially cardiovascular diseases (CVDs). We performed a parallel, three-arm randomized controlled trial (RCT) of 6-month educational intervention in a form of letters containing a reminder of the participant's CVD risk with or without Cochrane blogshots to reduce CVD risk among women aged 45-65 with one or more known CVD risk factors.

Methods: The control group received a letter about their CVD risk at the beginning of the trial. The intervention groups received the initial letter about their CVD risk and remainder letters about their CVD risk every 2 months, with or without Cochrane blogshots: (1) effect of calcium in the prevention of high blood pressure, (2) effect of reducing saturated fat acids in eating habits, and (3) effects of green and black tea in CVD prevention. The primary outcome was CVD risk reduction calculated as the difference between the baseline and 6-month score for a 10-year risk of fatal CVD according to the ACC/AHA guidelines.

Results: After both interventions, CVD risk reduction was significantly higher compared to the control group (P < 0.001, Kruskal-Wallis H test). The number of participants who decreased their CV risk was 29% (20/70) in the control group, 69% (48/70) in the group receiving the reminder letters, and 70% (49/70) in the group receiving the reminder letters and blogshots. The number needed to treat to achieve risk reduction was 2.41 (95% CI = 1.77 to 3.78) for letters with a CVD risk reminder and 2.50 (1.81 to 4.03) for letters with a reminder and a blogshot. The group receiving reminder letters with Cochrane blogshots had a significant change in the category of CVD risk, mainly from high to moderate and from moderate to low CVD risk category.

Conclusions: A simple and inexpensive intervention method in a form of letters reminding women about their CVD risk with or without providing additional health information in the form of Cochrane blogshots about interventions for important CVD risk factors may be effective in CVD management and could be considered by primary care providers.

Trial registration: ClinicalTrials.gov, NCT04601558. Retrospectively registered on October 19, 2020.

Keywords: CVD risk; Cochrane blogshots; Educational intervention; Women.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of the participants in the trial

References

    1. Buljan I, Tokalic R, Roguljic M, Zakarija-Grkovic I, Vrdoljak D, Milic P, et al. Comparison of blogshots with plain language summaries of Cochrane systematic reviews: a qualitative study and randomized trial. Trials. 2020;21(1):426. doi: 10.1186/s13063-020-04360-9.
    1. Sans S, Kesteloot H, Kromhout D. The burden of cardiovascular disease mortality in Europe. Eur Heart J. 1997;18(12):1231–1248. doi: 10.1093/oxfordjournals.eurheartj.a015434.
    1. Ijzelenberg W, Hellemans IM, van Tulder MW, Heymans MW, Rauwerda JA, van Rossum AC, et al. The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomized controlled trial. BMC Cardiovasc Disord. 2012;12:17. doi: 10.1186/1471-2261-12-71.
    1. Gracia M, Mulvagh SL, Merz CNB, Burnig JE, Manson JE. Cardiovascular disease in women: clinical perspectives. Circ Res. 2016;118(8):1273–1293. doi: 10.1161/CIRCRESAHA.116.307547.
    1. Hilleary RS, Jabusch SA, Zheng B, Jiroutek MR, Carter CA. Gender disparities in patient education provided during patient visits with a diagnosis of coronary heart disease. Womens Health (Lond). 2019;15. 10.1177/1745506519845591.
    1. Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005;111(4):499–510. doi: 10.1161/01.CIR.0000154568.43333.82.
    1. Shah T, Palaskas N, Ahmed A. An update on gender disparities in coronary heart disease care. Curr Atheroscler Rep. 2016;18(5):28. doi: 10.1007/s11883-016-0574-5.
    1. Hayes SN. Preventing cardiovascular disease in women. Am Fam Physician. 2006;74(8):1331–1340.
    1. Smiley WH., 3rd Getting patients to their lipid targets: a practical approach to implementing therapeutic lifestyle changes. J Am Osteopath Assoc. 2011;111(4 Suppl 3):eS13–eS17.
    1. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL. The Sixth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) Eur Heart J. 2016;37(29):2315–2381. doi: 10.1093/eurheartj/ehw106.
    1. McAlister FA, Stewart S, Ferrua S, McMurray JJJV. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol. 2004;44(4):810–819. doi: 10.1016/j.jacc.2004.05.055.
    1. Hansen L, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155(8):520–528. doi: 10.7326/0003-4819-155-8-201110180-00008.
    1. Guo Y, Chen Y, Lane DA, Liu L, Wang Y, Lip GYH. Mobile Health technology for atrial fibrillation management integrating decision support, education, and patient involvement: mAF app trial. Am J Med. 2017;130(12):1388–1396.e6. doi: 10.1016/j.amjmed.2017.07.003.
    1. Grønning K, Lim S, Bratås O. Health status and self-management in patients with inflammatory arthritis-a five-year follow-up study after nurse-led patient education. Nurs Open. 2019;7(1):326–333. doi: 10.1002/nop2.394.
    1. El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, et al. American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation. 2020;142(25):e506–e532. doi: 10.1161/CIR.0000000000000912.
    1. Cormick G, Ciapponi A, Cafferata ML, Belizan JM. Calcium supplementation for prevention of primary hypertension. Cochrane Database Syst Rev. 2015;2015(6):CD010037. doi: 10.1002/14651858.CD010037.pub2.
    1. Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;5(5):CD011737. doi: 10.1002/14651858.CD011737.pub2.
    1. Hartley L, Flowers N, Holmes J, Clarke A, Stranges S, Hooper L, et al. Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;2013(6):CD009934. doi: 10.1002/14651858.CD009934.pub2.
    1. Goff DC, Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49–S73. doi: 10.1161/01.cir.0000437741.48606.98.
    1. O’Connor AM. User manual – Decisional Conflict Scale. Ottawa: Ottawa Hospital Research Institute. 1993; updated 2010. . Accessed: 15 July 2022.
    1. O’Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25–30. doi: 10.1177/0272989X9501500105.
    1. Pavlicevic I, Skrabic S, Malicki M, Mercep AH, Marusic M, Marusic A. Decisional conflict and vaccine uptake: cross-sectional study of 2012/2013 influenza season in Croatia. Arch Med Sci. 2015;11(4):788–795. doi: 10.5114/aoms.2015.53299.
    1. Zimbardo PG, Boyd JN. Putting time in perspective: a valid, reliable individual-differences metric. J Pers Soc Psychol. 1999;77(6):1271–1288. doi: 10.1037/0022-3514.77.6.1271.
    1. McClure JB, Divine G, Alexander G, Tolsma D, Rolnick SJ, Stopponi M, et al. (2009) A comparison of smokers’ and nonsmokers’ fruit and vegetable intake and relevant psychosocial factors. Behav Med. 2009;35(1):14–22. doi: 10.3200/BMED.35.1.14-22.
    1. Karacic J, Dondio P, Buljan I, Hren D, Marusic A. Languages for different health information readers: multitrait-multimethod content analysis of Cochrane systematic reviews textual summary formats. BMC Med Res Methodol. 2019;19(1):75. doi: 10.1186/s12874-019-0716-x.
    1. Buljan I, Malicki M, Wager E, Puljak L, Hren D, Kellie F, et al. No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials. J Clin Epidemiol. 2018;97:86–94. doi: 10.1016/j.jclinepi.2017.12.003.
    1. Briss P, Rimer B, Reilley B, Coates RC, Lee NC, Mullen P, et al. Promoting informed decisions about cancer screening in communities and healthcare systems. Am J Prev Med. 2004;26(1):67–80. doi: 10.1016/j.amepre.2003.09.012.
    1. Desroches S, Gagnon MP, Tapp S, Legere F. Implementing shared decision-making in nutrition clinical practice: a theory-based approach and feasibility study. Implement Sci. 2008;3:48. doi: 10.1186/1748-5908-3-48.
    1. Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev. 2014;2014(4):CD007768. doi: 10.1002/14651858.CD007768.pub3.
    1. Stacey D, Legere F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4(4):CD001431. doi: 10.1002/14651858.CD001431.pub5.
    1. Neves AL, Freise L, Laranjo L, Carter AW, Darzi A, Mayer E. Impact of providing patients access to electronic health records on quality and safety of care: a systematic review and meta-analysis. BMJ Qual Saf. 2020;29(12):1019–1032. doi: 10.1136/bmjqs-2019-010581.
    1. Dickey LL. Promoting preventive care with patient-held minirecords: a review. Patient Educ Couns. 1993;20(1):37–47. doi: 10.1016/0738-3991(93)90115-d.
    1. Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJ. Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev. 2018;7(7):CD001271. doi: 10.1002/14651858.CD001271.pub3.
    1. Huntink E, Koetsenruijter J, Wensing M, van Lieshout J. Patient cardiovascular risk self-management: results from a randomized trial of motivational interviewing delivered by practice nurses. Fam Pract. 2019;36(4):460–466. doi: 10.1093/fampra/cmy087.
    1. Bokan I, Buljan I, Marusic M, Malicki M, Marusic M. Predictors of academic success and aspirations in secondary nursing education: a cross-sectional study in Croatia. Nurse Educ Today. 2020;88:104370. doi: 10.1016/j.nedt.2020.104370.
    1. Zhang X, Delvin HM, Smith B, Imperatore G, Thomas W, Lobelo F, et al. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: a systematic review and meta-analysis. PLoS One. 2017;12(5):e0176436. doi: 10.1371/journal.pone.0176436.

Source: PubMed

3
Se inscrever