Long-term maintenance of behavioral change to reduce health risk factors is essential to producing a positive effect on medical outcomes. The proposed study will determine whether an on going, long-term relationship can help patients with recent cardiac events or symptoms adhere to three risk-reduction behavioral interventions and to maintain healthy behavioral changes. The couples intervention is designed to (a) change the patient's physical and social environment to facilitate cardiac risk- reducing behavioral changes, (b) optimize social reinforcement and motivation for behavior change between the partners, and (c) decrease relationship stress related to patient's illness and other factors. The state-of-the-risk-reducing behavioral interventions will target three areas of change for cardiac patients in which long-term adherence is problematic: exercise, weight management, and adherence to lipid-lowering medication. Participants will be randomized to standard behavioral treatment or standard treatment plus the couples intervention. Following a pilot study to refine the couples intervention, 160 patients will be enrolled form Rush-Presbyterian-St.Luke's Medical Center and Cook County Hospital in Chicago. To enhance the salience of their health risks, participants will have had a cardiovascular event or acute symptoms (e.g., MI or angina) or a risk-reducing medical or surgical procedure (e.g., CABG or angioplasty). Participants will be referred to the study when their physician or medical caregiver determines that they require all three behavioral interventions to reduce their health risks (estimated as 50 percent of all patients eligible for cardiac rehabilitation). They must also have a partner (spouse or live- in-partner) who is willing to participate in the program should the participant be assigned to the couples component. Referral sources have been developed to obtain patients from diverse economic and social backgrounds. Patients will be followed in the study for 18 months. Behavioral outcomes to be assessed include adherence cardiac rehabilitation exercise regimen; exercise capacity; achievement of weight loss goals, maintenance of weight loss, and adherence to recommended dietary recommendations; and changes to lipid values and adherence to lipid-lowering medication. Psychosocial outcomes to be assessed include patient mood, illness coping, and quality of life. Health outcomes will also be monitored, including occurrence of acute events, hospitalizations, and changes in symptom patterns and medications. The study is intended to determine whether a short-term intervention to alter a long-term relationship can result in sustained behavioral change, improved quality of life, and on- going health benefits for heart patients.
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