Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT).
OBJECTIVE
Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. We hypothesized that the Life Goals Collaborative Care (LGCC) intervention, compared to enhanced usual care, would reduce CVD risk factors and improve physical and mental health outcomes in US Department of Veterans Affairs patients with bipolar disorder.


METHODS
Patients with an ICD-9 diagnosis of bipolar disorder and ≥ 1 CVD risk factor (N = 118) enrolled in the Self-Management Addressing Heart Risk Trial, conducted April 2008-May 2010, were randomized to LGCC (n = 58) or enhanced usual care (n = 60). Life Goals Collaborative Care included 4 weekly self-management sessions followed by tailored contacts combining health behavior change strategies, medical care management, registry tracking, and provider guideline support. Enhanced usual care included quarterly wellness newsletters sent during a 12-month period in addition to standard treatment. Primary outcome measures included systolic and diastolic blood pressure, nonfasting total cholesterol, and physical health-related quality of life.


RESULTS
Of the 180 eligible patients identified for study participation, 134 were enrolled (74%) and 118 completed outcomes assessments (mean age = 53 years, 17% female, 5% African American). Mixed effects analyses comparing changes in 24-month outcomes among patients in LGCC (n = 57) versus enhanced usual care (n = 59) groups revealed that patients receiving LGCC had reduced systolic (β = -3.1, P = .04) and diastolic blood pressure (β = -2.1, P = .04) as well as reduced manic symptoms (β = -23.9, P = .01). Life Goals Collaborative Care had no significant impact on other primary outcomes (total cholesterol and physical health-related quality of life).


CONCLUSIONS
Life Goals Collaborative Care, compared to enhanced usual care, may lead to reduced CVD risk factors, notably through decreased blood pressure, as well as reduced manic symptoms, in patients with bipolar disorder.


BACKGROUND
ClinicalTrials.gov identifier: NCT00499096.
VA Ann Arbor Center for Clinical Management Research and National Serious Mental Illness, Treatment Resource & Evaluation Center, North Campus Research Complex, 2800 Plymouth Rd, Bldg 14, Ann Arbor, MI 48109-2800, USA. amykilbo@umich.edu
Amy M
AM
Kilbourne
David E
DE
Goodrich
Zongshan
Z
Lai
Edward P
EP
Post
Karen
K
Schumacher
Kristina M
KM
Nord
Margretta
M
Bramlet
Stephen
S
Chermack
David
D
Bialy
Mark S
MS
Bauer
D032763:Behavior Control / Q000379:methods*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000523:psychology; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D005260:Female; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011788:Quality of Life; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care / Q000379:methods / Q000523:psychology; D012944:Social Support; D016896:Treatment Outcome