November 18th, 2013
Cutting-Edge Lifestyle and Behavioral Interventions — Promises and Challenges at AHA.13
Siqin Ye, MD
Several Cardiology Fellows who are attending AHA.13 in Dallas this week are blogging for CardioExchange. The Fellows include Vimal Ramjee, Siqin Ye, Seth Martin, Reva Balakrishnan, and Saurav Chatterjee. You can find the previous post here. For more of our AHA.13 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our AHA.13 Headquarters.
It’s bright and early in Dallas, and I’m at the second Late-Breaking Clinical Trial Session at the AHA 2013 Scientific Sessions, “Prevention: From Schools to Countries.”
In this session, Jaime Céspedes presented results from a educational intervention in Columbia that improved healthy eating habits in preschoolers. Nicole Li showed that a village-level salt reduction intervention in rural China reduced urinary sodium excretion but did not significantly affect blood pressure. Michael Ho discussed a low-cost, pharmacist-led adherence intervention consisting of medication reconciliation and phone-call refill reminders that targeted VA patients hospitalized for ACS, which effectively improved medication adherence and showed a trend for slightly improving clinical outcomes.
I was especially excited by a novel approach to effect lifestyle change by leveraging social networks, presented by Eric Ding. It has been observed in recent years that social networks can influence the spread of healthy and unhealthy behaviors. This led to the MICROCLINIC trial, which randomized social clusters of participants in Bell County, KY, to weekly and biweekly classes in settings that encouraged social support and diffusion. The approach effectively achieved losses in weight (-6.5 lbs, p<0.001) and waist circumference (-1.24 inches, p<0.001) compared to usual care at 10 months, and the results were largely sustained at 6 months. The discussant, Lawrence Appel, noted how much the observed effect was due to intervening on the social-network level. Further explorations into the issues of scalability and adaptability to different cultures are also needed.
Despite these caveats, I still believe we are about to enter into an exciting era in which new technologies and better understanding of factors underpinning human behavior will shift how we approach behavioral and lifestyle change. These advances should also help us meet the challenge of standardizing and implementing interventions in innovative ways to achieve scale. (As an example, my mentor, Karina Davidson, has done extensive work on standardized delivery of depression treatment to post-ACS patients.)
What are your thoughts on innovative behavioral interventions in cardiovascular medicine and ways to implement and sustain them?
One Response to “Cutting-Edge Lifestyle and Behavioral Interventions — Promises and Challenges at AHA.13”
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I agree with your thoughts Siqin – it is an exciting time to see the development of novel strategies to achieve sustainable lifestyle interventions, especially in an era when medication adherence has been found to be dismal even when medications are free (<60% as Dr. Ho pointed out in the background to the Medication study). We do need to find new ways to engage our patients to be more proactive in their own care, and I think this is definitely an area of opportunity for new and exciting research for fellows to brainstorm ideas.
The 2 trials that impressed me with novel strategies were from Dr. Cepedes presentation of follow up data on cardiovascular health promotion in preschool children which showed sustainable results 3 yrs after the intervention- it involved education targeted at teachers and family in addition to the children themselves; and the Microclinic trial – which involved the support networks of family and friends. Perhaps this strategy will have more success than more traditional techniques such as the post-discharge pharmacist intervention (as was presented in the negative results of the Medication study presented by Dr. Ho). The only question that I thought of for the Microclinic trial was that the control group did not receive any "standard" form of education, so were the effects that were seen a result of the utilizing the social network technique, or of the education itself? I definitely agree with you though – I'm excited to see how these new strategies will be used in future studies.