Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile: a randomized controlled trial.
BACKGROUND
Although the use of electron beam tomography (EBT) as a motivational tool to change behavior is practiced, its efficacy has not been studied.


OBJECTIVE
To assess the effects of incorporating EBT as a motivational factor into a cardiovascular screening program in the context of either intensive case management (ICM) or usual care by assessing its impact over 1 year on a composite measure of projected risk.


METHODS
Randomized controlled trial with a 2 x 2 factorial design and 1 year of follow-up.


METHODS
A consecutive sample of 450 asymptomatic active-duty US Army personnel aged 39 to 45 years stationed within the Washington, DC, area and scheduled to undergo a periodic Army-mandated physical examination were enrolled between January 1999 and March 2001 (mean age, 42 years; 79% male; 66 [15%] had coronary calcification; mean [SD] predicted 10-year coronary risk, 5.85% [3.85%]).


METHODS
Patients were randomly assigned to 1 of 4 intervention arms: EBT results provided in the setting of either ICM (n = 111) or usual care (n = 119) or EBT results withheld in the setting of either ICM (n = 124) or usual care (n = 96).


METHODS
The primary outcome measure was change in a composite measure of risk, the 10-year Framingham Risk Score (FRS).


RESULTS
Comparing the groups who received EBT results with those who did not, the mean absolute risk change in 10-year FRS was +0.30 vs +0.36 (P =.81). Comparing the groups who received ICM with those who received usual care, the mean absolute risk change in 10-year FRS was -0.06 vs +0.74 (P =.003). Improvement or stabilization of cardiovascular risk was noted in 157 patients (40.2%). In multivariable analyses predicting change in FRS, after controlling for knowledge of coronary calcification, motivation for change, and multiple psychological variables, only the number of risk factors (odds ratio, 1.42; 95% confidence interval, 1.16-1.75 for each additional risk factor) and receipt of ICM (odds ratio, 1.62; 95% confidence interval, 1.04-2.52) were associated with improved or stabilized projected risk.


CONCLUSIONS
Using coronary calcification screening to motivate patients to make evidence-based changes in risk factors was not associated with improvement in modifiable cardiovascular risk at 1 year. Case management was superior to usual care in the management of risk factors.
Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. patrick.omalley@amedd.army.mil
Patrick G
PG
O'Malley
Irwin M
IM
Feuerstein
Allen J
AJ
Taylor
D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019090:Case Management; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008403:Mass Screening; D009042:Motivation; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed