New approaches to implement proven preventive and lifestyle interventions are needed to reach the NHLBI strategic plan goal to speed the translation of science into practice and reduce the public health burden of cardiovascular disease (CVD). It has been established that cardiac caregivers are a vehicle by which health information can be transmitted, and that caregivers themselves may be at increased CVD risk. Our research will evaluate the potential pool and demographic profile of cardiac caregivers as well as the role(s) they play in improving quality of patient care and to enhance adherence to secondary prevention guidelines post discharge. This research will also provide important information about targeting educational efforts to specific caregivers to enhance the clinical outcomes of hospitalized coronary patients. The purpose of this study is to estimate the prevalence of caregiving in hospitalized cardiac patients by demographic factors such as patient age and race/ethnicity, and to link caregiving to clinical outcomes in cardiac patients. A secondary aim is to collect family tree data which will allow us to estimate the number of first degree family members, their basic demographics, and the distance at which they live from the medical center in order to determine the feasibility and scope of a targeted preventive intervention.
The specific aims are to determine: 1) the prevalence and demographic characteristics of primary cardiac caregivers among patients admitted with an acute atherosclerotic coronary event or surgical or catheter-based coronary revascularization procedure during a consecutive 6 month period at a major academic teaching hospital, 2) the relation between having or not having a cardiac caregiver and patient clinical outcomes at 30 days post hospital discharge adjusted for patient demographic characteristics, admitting diagnoses, and co-morbidities, 3) feasibility of an extended family-centered educational and behavioral intervention that will include an outreach to family members of patients hospitalized with CVD to ensure appropriate screening, lifestyle education, and referral of family members for evidence-based risk reduction therapies when appropriate. The significance of this research is that it addresses specific challenges outlined in the recent NHLBI strategic plan to develop and evaluate programs to improve patient, provider, and health care system behavior and performance to enhance quality of care and health outcomes, especially in populations that experience a disproportionate disease burden. Unique information will be obtained about caregivers as a potential intervention to improve preventive care and health outcomes of patients and families that suffer disproportionate CVD burden. Improved adherence to evidence-based preventive therapies could have a substantial public health benefit.
Project Relevance Adherence to evidence-based secondary prevention therapies has been shown to cut the death rate due to heart disease in half and reduction in major risk factors has a similar impact. This research addresses a public health and scientific challenge to develop and test novel interventions to increase adherence to secondary prevention guidelines among patients hospitalized with cardiovascular disease by educating and engaging a caregiver/prevention partner to encourage lifestyle and medication adherence in the patient. The study will also determine the effect of educating and supporting the caregiver on their own lifestyle, risk of depression, and caregiver strain, which impacts their own cardiovascular health.
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