COLORADO SPRINGS — A novel in-hospital lifestyle intervention aimed at family members visiting a relative hospitalized with cardiac disease pays dividends in terms of improved heart-healthy dietary habits.
Moreover, the members most likely to improve their diet in response to the hour-long counseling session tended to be those with baseline elevated cardiovascular risk factors and lower self-perceived health status, Dr. Lori Mosca said at a conference sponsored by the American Heart Association.
“When a family member has someone hospitalized for heart disease it's an opportune time to help them learn about their own risk for heart disease and [how] to lower it. It's what we call the motivational moment,” Dr. Mosca, professor of medicine and director of preventive cardiology at New York-Presbyterian Hospital, said in an interview. “Interventions will be more effective when timed correctly and targeted to the right audience. The more threatened people feel by a condition, the more likely they are to adhere to preventive therapy.”
Dr. Mosca is principal investigator for the ongoing National Institutes of Health- funded Family Intervention Trial for Heart Health (F.I.T. Heart). In an interim analysis reported at the meeting, adherence to the National Cholesterol Education Program's Therapeutic Lifestyle Change diet in 189 family members who went through the intervention rose from 53% at baseline to 79% at follow-up 6 weeks later. Of those who received the intervention 77% showed a significant improvement in their diet score at 6 weeks' follow-up.
In the next phase, Dr. Mosca plans to document whether intervening with family members has a beneficial spillover effect on the cardiac patients. About half of the family members participating in the project are responsible for caring for the patient. “If we teach them about diet, there could potentially be a very important domino effect.”
Here's how the F.I.T. Heart intervention works: When patients enter the hospital with an MI or for a coronary revascularization procedure, they're given a pamphlet explaining the program and inviting family members to attend. The prevention counselors, who are dietitians or health educators, go out onto the floors and invite family members to come by the counseling room on the cardiac floor for a cardiovascular risk factor assessment and risk-lowering suggestions. There is no charge for the program, which the hospital has been running for 5 years as a community outreach project. “It's a modest amount of resources, and the downstream effect is going to be very important,” she noted.
The study has found that family members who care for a cardiac patient had higher levels of cardiovascular risk factors, higher psychosocial strain scores, less social support, and more depressive symptoms than did noncaregivers. The fact that caregivers may themselves be at increased risk of heart disease is not surprising, since they share lifestyle factors, and often genes, with the patient, Dr. Mosca noted.
'It's a modest amount of resources, and the downstream effect is going to be very important.' DR. MOSCA