title: Reduction in 2-year recurrent risk score and improved behavioral outcomes after participation in the "Beating Heart Problems" self-management program: results of a randomized controlled trial.
abstract: OBJECTIVE
  While behavior change can improve risk factor profiles and prognosis after an acute cardiac event, patients need assistance to achieve sustained lifestyle changes. We developed the "Beating Heart Problems" cognitive-behavioral therapy and motivational interviewing program to support patients to develop behavioral and cognitive self-management skills. We report the results of a randomized controlled trial of the program.
  
  
  METHODS
  Patients (n = 275) consecutively admitted to 2 Melbourne hospitals after acute myocardial infarction (32%), coronary artery bypass graft surgery (40%), or percutaneous coronary intervention (28%) were randomized to treatment (T; n = 139) or control (C; n = 136). T group patients were invited to participate in the 8-week group-based program. Patients underwent risk factor screening 6 weeks after hospital discharge (before randomization) and again 4 and 12 months later. At both the followups, T and C groups were compared on 2-year risk of a recurrent cardiac event and key behavioral outcomes, using both intention-to-treat and "completers only" analyses.
  
  
  RESULTS
  Patients ranged in age from 32 to 75 years (mean = 59.0 years; SD - 9.1 years). Most patients (86%) were men. Compared with the C group patients, T group patients tended toward greater reduction in 2-year risk, at both the 4- and 12-month followups. Significant benefits in dietary fat intake and functional capacity were also evident.
  
  
  CONCLUSIONS
  The "Beating Heart Problems" program showed modest but important benefit over usual care at 4 and, to a lesser extent, 12 months. Modifications to the program such as the inclusion of booster sessions and translation to online delivery are likely to improve outcomes.
authors.affiliation: Heart Research Centre and Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia. barbara.murphy@heartresearchcentre.org
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Murphy
authors.forename: Marian U C
authors.initials: MU
authors.lastname: Worcester
authors.forename: Rosemary O
authors.initials: RO
authors.lastname: Higgins
authors.forename: Peter C
authors.initials: PC
authors.lastname: Elliott
authors.forename: Michael R
authors.initials: MR
authors.lastname: Le Grande
authors.forename: Fiona
authors.initials: F
authors.lastname: Mitchell
authors.forename: Hema
authors.initials: H
authors.lastname: Navaratnam
authors.forename: Alyna
authors.initials: A
authors.lastname: Turner
authors.forename: Leeanne
authors.initials: L
authors.lastname: Grigg
authors.forename: James
authors.initials: J
authors.lastname: Tatoulis
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Goble
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome