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A monthly peer-led support program for adults with risk factors for heart disease achieved small but significant gains in overall cardiovascular health and smoking cessation, according to a multicenter, randomized, controlled trial.
After 12 months, participants scored an average of 0.75 points higher than baseline on a novel composite measure of cardiovascular health – the Fuster-BEWAT Score (FBS) – compared with controls, reported Emilia Gómez, Ph.D., at SHE Foundation, Barcelona, Dr. Juan Miguel Fernández-Alvira of Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, and their associates.
“Even though the magnitude of the impact of our intervention was modest, epidemiological data suggest that even very small changes in health behaviors and risk factors can significantly decrease the long-term risk of cardiovascular disease,” the investigators wrote. They presented the findings at the American Heart Association scientific sessions and simultaneously in the Journal of the American College of Cardiology.
Peer support has been used for managing various chronic diseases, but the Fifty-Fifty Program is the first multicenter, randomized trial to assess its efficacy while also accounting for baseline health education, said the investigators.
To do so, they designed a run-in of six workshops for 543 adults aged 25-50 years who had hypertension, were overweight or obese, smoked, or exercised 150 minutes or less a week. The participants, 71% of whom were female, were then randomized to receive no further support or to attend monthly, 60- to 90-minute sessions that included role playing, brainstorming, and activities focused on managing emotions, diet, and exercise. The 10 members of each group elected their own leaders, who then completed 3 hours of training in health promotion and leadership.
After 12 months, the intervention group scored an average of 8.84 (95% confidence interval, 8.37-9.32) on the FBS’ composite measure of blood pressure, exercise, weight, diet, and tobacco use, compared with 8.17 for controls (95% CI, 7.55-8.79; P = .016). The intervention group also improved 0.75 points more from baseline, compared with controls (95% CI, 0.32-1.18).
In addition, support group members scored 0.24 points higher on the 1-year measure of tobacco cessation (95% CI, 0.09-0.38; P = .003). The groups did not otherwise significantly differ in terms of individual risk factors, but the intervention group outscored the control group on measures of blood pressure, exercise, and diet.
“The results of the Fifty-Fifty study show that promoting healthier lifestyles focusing on self control of unhealthy behaviors through peer group support can be beneficial to heterogeneous groups, without a single condition or specific CV risk factors,” the researchers concluded. “Although this is a relatively short-term intervention study, follow-up results will provide insight into long-term sustainability of peer group support and long-term effect on cardiovascular health.”
The SHE Foundation and the Spanish Ministry of Health, Social Services and Equality jointly funded the research. The investigators did not report conflicts of interest.
The Fifty-Fifty Program offers several innovations to the field of cardiovascular prevention. First, the program did not just address one risk factor, but instead emphasized multiple aspects of cardiovascular health, including health behaviors (healthy diet and increasing physical activity) and health metrics (blood pressure and body mass index) as measured by the novel risk score, the FBS. The ability of the FBS to predict clinical outcomes has not been fully validated; but all of the included measures are intimately linked to cardiovascular health and easily reproducible in other settings, since they consist of only health behaviors and non-laboratory–based health factors.
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Dr. Fatima Rodriguez |
Second, the Fifty-Fifty Program employed the widely used psychological interventions of peer support and group dynamics to yield modest yet positive results in CVH improvement at 1 year follow-up. Importantly, participants in the study selected the peer leaders. When interventions have this type of community buy-in, they are more likely to be successful. Finally, peer-based interventions are more likely to be self sustainable and scalable in the long term, and have wide applicability in diverse and resource-limited settings.
An important limitation of the Fifty-Fifty program was its attrition rate of 16%. Those who dropped out of the study tended to be younger and to have less favorable CVH profiles, which may have created selection bias and impacted the generalizability of the results.
Dr. Fatima Rodriguez is with the division of cardiovascular medicine, Stanford (Calif.) University. Dr. Robert Harrington is with the department of medicine, Stanford University. They reported no conflicts of interest.
The Fifty-Fifty Program offers several innovations to the field of cardiovascular prevention. First, the program did not just address one risk factor, but instead emphasized multiple aspects of cardiovascular health, including health behaviors (healthy diet and increasing physical activity) and health metrics (blood pressure and body mass index) as measured by the novel risk score, the FBS. The ability of the FBS to predict clinical outcomes has not been fully validated; but all of the included measures are intimately linked to cardiovascular health and easily reproducible in other settings, since they consist of only health behaviors and non-laboratory–based health factors.
|
Dr. Fatima Rodriguez |
Second, the Fifty-Fifty Program employed the widely used psychological interventions of peer support and group dynamics to yield modest yet positive results in CVH improvement at 1 year follow-up. Importantly, participants in the study selected the peer leaders. When interventions have this type of community buy-in, they are more likely to be successful. Finally, peer-based interventions are more likely to be self sustainable and scalable in the long term, and have wide applicability in diverse and resource-limited settings.
An important limitation of the Fifty-Fifty program was its attrition rate of 16%. Those who dropped out of the study tended to be younger and to have less favorable CVH profiles, which may have created selection bias and impacted the generalizability of the results.
Dr. Fatima Rodriguez is with the division of cardiovascular medicine, Stanford (Calif.) University. Dr. Robert Harrington is with the department of medicine, Stanford University. They reported no conflicts of interest.
The Fifty-Fifty Program offers several innovations to the field of cardiovascular prevention. First, the program did not just address one risk factor, but instead emphasized multiple aspects of cardiovascular health, including health behaviors (healthy diet and increasing physical activity) and health metrics (blood pressure and body mass index) as measured by the novel risk score, the FBS. The ability of the FBS to predict clinical outcomes has not been fully validated; but all of the included measures are intimately linked to cardiovascular health and easily reproducible in other settings, since they consist of only health behaviors and non-laboratory–based health factors.
|
Dr. Fatima Rodriguez |
Second, the Fifty-Fifty Program employed the widely used psychological interventions of peer support and group dynamics to yield modest yet positive results in CVH improvement at 1 year follow-up. Importantly, participants in the study selected the peer leaders. When interventions have this type of community buy-in, they are more likely to be successful. Finally, peer-based interventions are more likely to be self sustainable and scalable in the long term, and have wide applicability in diverse and resource-limited settings.
An important limitation of the Fifty-Fifty program was its attrition rate of 16%. Those who dropped out of the study tended to be younger and to have less favorable CVH profiles, which may have created selection bias and impacted the generalizability of the results.
Dr. Fatima Rodriguez is with the division of cardiovascular medicine, Stanford (Calif.) University. Dr. Robert Harrington is with the department of medicine, Stanford University. They reported no conflicts of interest.
A monthly peer-led support program for adults with risk factors for heart disease achieved small but significant gains in overall cardiovascular health and smoking cessation, according to a multicenter, randomized, controlled trial.
After 12 months, participants scored an average of 0.75 points higher than baseline on a novel composite measure of cardiovascular health – the Fuster-BEWAT Score (FBS) – compared with controls, reported Emilia Gómez, Ph.D., at SHE Foundation, Barcelona, Dr. Juan Miguel Fernández-Alvira of Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, and their associates.
“Even though the magnitude of the impact of our intervention was modest, epidemiological data suggest that even very small changes in health behaviors and risk factors can significantly decrease the long-term risk of cardiovascular disease,” the investigators wrote. They presented the findings at the American Heart Association scientific sessions and simultaneously in the Journal of the American College of Cardiology.
Peer support has been used for managing various chronic diseases, but the Fifty-Fifty Program is the first multicenter, randomized trial to assess its efficacy while also accounting for baseline health education, said the investigators.
To do so, they designed a run-in of six workshops for 543 adults aged 25-50 years who had hypertension, were overweight or obese, smoked, or exercised 150 minutes or less a week. The participants, 71% of whom were female, were then randomized to receive no further support or to attend monthly, 60- to 90-minute sessions that included role playing, brainstorming, and activities focused on managing emotions, diet, and exercise. The 10 members of each group elected their own leaders, who then completed 3 hours of training in health promotion and leadership.
After 12 months, the intervention group scored an average of 8.84 (95% confidence interval, 8.37-9.32) on the FBS’ composite measure of blood pressure, exercise, weight, diet, and tobacco use, compared with 8.17 for controls (95% CI, 7.55-8.79; P = .016). The intervention group also improved 0.75 points more from baseline, compared with controls (95% CI, 0.32-1.18).
In addition, support group members scored 0.24 points higher on the 1-year measure of tobacco cessation (95% CI, 0.09-0.38; P = .003). The groups did not otherwise significantly differ in terms of individual risk factors, but the intervention group outscored the control group on measures of blood pressure, exercise, and diet.
“The results of the Fifty-Fifty study show that promoting healthier lifestyles focusing on self control of unhealthy behaviors through peer group support can be beneficial to heterogeneous groups, without a single condition or specific CV risk factors,” the researchers concluded. “Although this is a relatively short-term intervention study, follow-up results will provide insight into long-term sustainability of peer group support and long-term effect on cardiovascular health.”
The SHE Foundation and the Spanish Ministry of Health, Social Services and Equality jointly funded the research. The investigators did not report conflicts of interest.
A monthly peer-led support program for adults with risk factors for heart disease achieved small but significant gains in overall cardiovascular health and smoking cessation, according to a multicenter, randomized, controlled trial.
After 12 months, participants scored an average of 0.75 points higher than baseline on a novel composite measure of cardiovascular health – the Fuster-BEWAT Score (FBS) – compared with controls, reported Emilia Gómez, Ph.D., at SHE Foundation, Barcelona, Dr. Juan Miguel Fernández-Alvira of Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, and their associates.
“Even though the magnitude of the impact of our intervention was modest, epidemiological data suggest that even very small changes in health behaviors and risk factors can significantly decrease the long-term risk of cardiovascular disease,” the investigators wrote. They presented the findings at the American Heart Association scientific sessions and simultaneously in the Journal of the American College of Cardiology.
Peer support has been used for managing various chronic diseases, but the Fifty-Fifty Program is the first multicenter, randomized trial to assess its efficacy while also accounting for baseline health education, said the investigators.
To do so, they designed a run-in of six workshops for 543 adults aged 25-50 years who had hypertension, were overweight or obese, smoked, or exercised 150 minutes or less a week. The participants, 71% of whom were female, were then randomized to receive no further support or to attend monthly, 60- to 90-minute sessions that included role playing, brainstorming, and activities focused on managing emotions, diet, and exercise. The 10 members of each group elected their own leaders, who then completed 3 hours of training in health promotion and leadership.
After 12 months, the intervention group scored an average of 8.84 (95% confidence interval, 8.37-9.32) on the FBS’ composite measure of blood pressure, exercise, weight, diet, and tobacco use, compared with 8.17 for controls (95% CI, 7.55-8.79; P = .016). The intervention group also improved 0.75 points more from baseline, compared with controls (95% CI, 0.32-1.18).
In addition, support group members scored 0.24 points higher on the 1-year measure of tobacco cessation (95% CI, 0.09-0.38; P = .003). The groups did not otherwise significantly differ in terms of individual risk factors, but the intervention group outscored the control group on measures of blood pressure, exercise, and diet.
“The results of the Fifty-Fifty study show that promoting healthier lifestyles focusing on self control of unhealthy behaviors through peer group support can be beneficial to heterogeneous groups, without a single condition or specific CV risk factors,” the researchers concluded. “Although this is a relatively short-term intervention study, follow-up results will provide insight into long-term sustainability of peer group support and long-term effect on cardiovascular health.”
The SHE Foundation and the Spanish Ministry of Health, Social Services and Equality jointly funded the research. The investigators did not report conflicts of interest.
From the AHA Scientific Sessions
Key clinical point: A peer support program was linked to significantly improved cardiovascular health, and to tobacco cessation.
Major finding: At 12 months, the mean composite cardiovascular health score was 8.84 for the intervention group, and 8.17 for controls (P = .016).
Data source: Multicenter, randomized, controlled trial of 543 adults with at least one risk factor for cardiovascular disease.
Disclosures: The SHE Foundation and the Spanish Ministry of Health, Social Services and Equality jointly funded the research. The investigators did not report conflicts of interest.
