title: Designing and implementing a comparative effectiveness study of two strategies for delivering high quality CHD prevention: methods and participant characteristics for the Heart to Health study.
abstract: BACKGROUND
  Although lifestyle and medications are effective for coronary heart disease (CHD) risk reduction, few studies have examined the comparative effectiveness of various strategies for delivering high quality CHD risk reduction. In this paper, we report on the design and baseline characteristics of participants for just such a trial.
  
  
  METHODS
  We conducted a randomized trial of the same lifestyle and medication intervention delivered in two alternate formats: counselor-delivered or web-based. The trial was conducted at 5 diverse practices in a family medicine research network and included men and women age 35-79 who were at high risk of CHD events based on 10-year predicted Framingham risk of ≥10% or a known history of cardiovascular disease. After individual-level randomization, participants in both arms received a decision aid plus four intensive intervention visits and 3 maintenance visits over 12 months. The primary outcome was change in 10-year predicted CHD risk among patients without prior cardiovascular disease. Secondary outcomes, measured among all participants, included changes in CHD risk factors, cost-effectiveness, and acceptability at 4 and 12-month follow-up.
  
  
  RESULTS
  We randomized 489 eligible patients: 389 without and 100 with a known history of cardiovascular disease. Mean age was 62.3. 75% were white, 25% African-American. 45% had a college education. 88% had health insurance. Mean 10-year predicted CHD risk was 16.9%.
  
  
  CONCLUSIONS
  We have successfully recruited a diverse sample of practices and patients that will provide a rich sample in which to test the comparative effectiveness of two strategies to implement high quality CHD prevention.
authors.affiliation: Division of General Medicine and Clinical Epidemiology, CB 7110, University of North Carolina, Chapel Hill, NC 27599, United States; Center for Health Promotion and Disease Prevention, CB 7426, University of North Carolina, Chapel Hill, NC 27599, United States; Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina, Chapel Hill, NC 27599, United States. Electronic address: sls593@med.unc.edu.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Sheridan
authors.forename: Lindy B
authors.initials: LB
authors.lastname: Draeger
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Carmen
authors.initials: C
authors.lastname: Samuel-Hodge
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.forename: Maihan B
authors.initials: MB
authors.lastname: Vu
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Gitterman
authors.forename: Shrikant I
authors.initials: SI
authors.lastname: Bangdiwala
authors.forename: Katrina E
authors.initials: KE
authors.lastname: Donahue
authors.forename: Kelly
authors.initials: K
authors.lastname: Evenson
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ammerman
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Keyserling
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D057186:Comparative Effectiveness Research / Q000379:methods*; D003327:Coronary Disease / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003376:Counseling; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017216:Telemedicine; D016896:Treatment Outcome
keywords: Coronary heart disease; Counseling; Evidence-based practice; Prevention; Therapy/computer-assisted
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