RiskCom: The Effectiveness of Personalized Stroke Risk Communication

Sponsor

Durham VA Medical Center (U.S. Fed)

Overall Status

Completed

CT.gov ID

NCT01178060

Collaborator

(none)

Enrollment

Location

Arms

Duration (Months)

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The goal of this research is to improve communication to Veterans. The investigators want to improve how doctors and nurses talk to patients about the risk of heart attack and stroke. The investigators will give everyone in the study information about the risk for heart attack or stroke. The investigators will also provide information on how to reduce this risk. This information will be given in one of two ways. The investigators want to see which way of giving information works better for veterans. The investigators also want to assess the impact of personalized stroke risk communication to patients at risk for stroke on patient knowledge, beliefs, and preferences for risk reduction behaviors and evaluate the impact of personalized risk communication on medication adherence and blood pressure. The investigators plan to enroll approximately 100 veterans for this study. All veterans will be from the Durham VA Primary Care Clinics. The investigators will ask everyone to be in the study for 3 months.

Condition or Disease	Intervention/Treatment	Phase
Cardiovascular Disease Stroke	Other: Personalized Heart Attack and Stroke Risk Other: Standard Education	N/A

Detailed Description

Background:

In 2005, over 17,000 patients were treated for stroke within the VA with a cost of almost $315 million. Prevention of stroke through reduction of established risk factors is an essential part of the VA Stroke QUERI strategic plan for the VA. In spite of this, in the Veterans Affairs, only 13% of patients with known CVD achieve target BP and cholesterol control. Combining risk factors into a composite measure of risk offers a better global assessment of individual risk and is recommended by the American Heart Association and American Stroke Association for prioritizing interventions. This practice is rarely done in routine clinical practice and its use as a tool to motivate patient behavior has not been tested. Current evidence from VA patients suggests that patients with hypertension do not adequately translate their risk factors into an accurate estimation of stroke risk. Improving the accuracy of stroke risk perceptions may be particularly important in motivating risk reduction in patients.

Objectives:

The objectives of this study are to: 1.) Assess the impact of personalized stroke risk communication to patients at risk for stroke on patient knowledge, beliefs, and preferences for risk reduction behaviors. 2.) Evaluate the impact of personalized risk communication on medication adherence and blood pressure. 3.) Explore the feasibility and obtain sample size estimates for a larger, investigator initiative research (IIR) application testing this tool.

Methods:

A two-group randomized controlled trial testing a personalized risk communication intervention compared to an education-only control group was conducted. Eighty-nine patients were randomized and followed for 3months. Both groups received written and verbal patient education on stroke risk factors and prevention. Patients in the intervention arm also received personalized risk communication based on the Framingham stroke and coronary heart disease risk scores. A verbal and graphic presentation of their personal risk, risk relative to an age matched cohort, and their optimal or target risk based on optimal risk factor modification was presented. Outcomes measured immediately following the intervention and at 3months included: risk perception and worry; risk factor knowledge; decision preference and conflict; medication adherence; health behaviors; and blood pressure.

Status:

The study finished enrollment and all follow-up visits have been completed. The data from this project is being analyzed.

Study Design

Study Type:

Interventional

Actual Enrollment :

90 participants

Allocation:

Randomized

Intervention Model:

Factorial Assignment

Masking:

None (Open Label)

Primary Purpose:

Health Services Research

Official Title:

The Effectiveness of Personalized Stroke Risk Communication - A Pilot Randomized Controlled Trial

Study Start Date :

Sep 1, 2008

Actual Primary Completion Date :

Dec 1, 2009

Actual Study Completion Date :

Dec 1, 2009

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Personalized Risk Information Patients received personalized stroke and heart attack risk assessment information.	Other: Personalized Heart Attack and Stroke Risk Personalized assessment of heart attack and stroke risk based on 10yr predictors with individual risk factors.
Other: Standard Education Patients received general risk information on heart attack and stroke.	Other: Standard Education Patients received a general handout describing risk factors for heart attack and stroke.

Arm

Intervention/Treatment

Active Comparator: Personalized Risk Information

Patients received personalized stroke and heart attack risk assessment information.

Other: Personalized Heart Attack and Stroke Risk

Personalized assessment of heart attack and stroke risk based on 10yr predictors with individual risk factors.

Other: Standard Education

Patients received general risk information on heart attack and stroke.

Other: Standard Education

Patients received a general handout describing risk factors for heart attack and stroke.

Outcome Measures

Primary Outcome Measures

Impact of personalized risk information [baseline]
Assess the impact of personalized risk communication to patients at risk for stroke on patient knowledge, beliefs, and preferences for risk reduction behaviors.
Impact of personalized risk information [3 month]
Assess the impact of personalized risk communication to patients at risk for stroke on patient knowledge, beliefs, and preferences for risk reduction behaviors.

Secondary Outcome Measures

Evaluate impact on medication adherence [3-months]
Evaluate the impact of personalized risk communication on medication adherence at 3-months

Eligibility Criteria

Criteria

Ages Eligible for Study:

55 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Enrolled in a Durham VA Primary Care Clinic for at least one year
Age ≥ 55 years old
Diagnosis ICD 401.0, 401.1, or 401.9 on outpatient electronic encounter forms in the prior year
Received a prescription for hypertensive medication (ACE inhibitors, beta blockers, calcium channel blockers, diuretics, alpha1 blockers, and/or central alpha2 agonists) in the previous year
Inadequate BP control based on an average of prior 12-month clinic BP measurements
Have a baseline EKG within the last 5 years to evaluate the presence of left ventricular hypertrophy.

Exclusion Criteria:

Hospitalized at the DVAMC for a myocardial infarction (MI), coronary artery revascularization, or diagnosis of metastatic cancer in the past 6 months
Prior history of stroke
Active diagnosis of psychosis or dementia documented in medical record
Participating in another chronic disease self-management study
Resident of a nursing home
Does not have access to a telephone
Refusal to provide informed consent