Abstract
PURPOSE: Secondary prevention interventions, including hospital clinics, can help patients improve their risk factors and lifestyles after an acute cardiac event. This study aimed to investigate the long-term behavioral outcomes of attending and nonattending patients consecutively enrolled in a trial of a family-based clinic providing screening, advice, and support 3 months after hospital admission. The study also aimed to identify predictors of long-term smoking status, dietary habit, and physical activity.
METHODS: Semistructured interviews were conducted an average of 30 months after the acute cardiac event with 83 of the 103 nonattending patients and a random sample of 96 patients who had attended the clinic. Behavioral outcomes were investigated, and self-reported risk factors at the time of the acute illness were documented.
RESULTS: The patients who had attended the clinic were significantly more likely than nonattenders to report positive dietary changes and, among former smokers, successful cessation of smoking. Furthermore, they reported being more physically active than nonattenders. Using logistic regression, clinic attendance was identified as a significant and independent predictor of all three outcomes.
CONCLUSIONS: The results of this observational study suggest that attendance at a secondary prevention clinic facilitates maintenance of improved long-term health behaviors, although this finding is based on self-report. Factors possibly responsible for favorable outcomes include strong physician advice and support from a multidisciplinary team of health professionals. Furthermore, the timing of the intervention may have been appropriate for enrollment in a secondary prevention clinic.
Modification of cardiovascular risk factors significantly reduces mortality and morbidity after an acute cardiac event. 1-3 Cardiac rehabilitation programs provide an opportunity for secondary prevention and have been demonstrated to have a favorable impact on morbidity and mortality. 4,5 However, participation rates are disappointingly low. 6-8 Furthermore, although cardiac rehabilitation programs can help patients to initiate the process of behavior change, their usual duration of 6 to 13 weeks is too short to ensure long-term maintenance of lifestyle changes. 9 After initial adherence to prescribed regimens, relapse is common. For example, resumption of smoking frequently occurs after acute myocardial infarction and coronary artery bypass surgery. 1,10,11
To achieve adherence to regimens and sustained behavior changes, reinforcement of advice and ongoing support appear to be required. Secondary prevention trials involving clinic attendance, exercise, education, and support lasting several months or years have achieved favorable risk factor outcomes and a significant reduction in mortality and morbidity. 12-15 Interventions with a single health professional 16 or a multidisciplinary team 16-19 providing regular telephone contact also have proved to be effective strategies for secondary prevention of cardiovascular disease. Behavioral interventions that concentrate on relapse prevention have produced benefits in terms of risk factor modification. 17,18 In addition, primary prevention studies targeting family groups have achieved some positive results. 20-22
To determine whether a family-based clinic addressing both primary and secondary prevention can be effective, a trial entitled the Family Atherosclerosis Risk Intervention Study (FARIS) was conducted. Family members also were recruited to encourage patients to attend the clinic. Details of the study design and the risk factor profiles of patients and relatives are reported elsewhere. 23
This report describes the long-term behavioral outcomes for patients enrolled in FARIS. The study aim first to determine whether there were differences in health behaviors at follow-up evaluation between patients who had attended the FARIS clinic and the nonattending invited patients. Second, the study aimed to identify key predictors of long-term behavioral outcomes including cigarette smoking, dietary pattern, and physical activity during leisure.