veteran peer coaches optimizing and advancing cardiac health

Conditions: Cardiovascular Disease (CVD); Hypertension; Hyperlipemia; Obesity

Summary: the purpose of this study is to test if having a veteran peer health coach will improve blood pressure control among veterans with high blood pressure and at least one other cardiovascular disease (cvd) risk factor. the intervention will deliver brief health messages, discuss goal setting, and action planning around health behavior changes shown to decrease cvd risk, including healthy diet, regular to moderate-intensity physical activity, and smoking cessation. facilitators, barriers, and costs of the intervention will be determined.

the vet-coach study is a peer health coaching program to help reduce cardiovascular disease (cvd) risk among veterans. the goal of the study is to test the effectiveness of a home-visit peer health coach intervention to promote health outcomes and behavior change among veterans with multiple cvd risk factors with a hybrid type 1 implementation study. the study will focus on veterans with poorly controlled hypertension and at least one other cvd risk factor to target a high risk population. the study will conduct a randomized controlled trial to enroll n=400 veterans to compare a peer health coach intervention consisting of home visits, telephone support, and linkages to appropriate community-based and clinic resources compared to usual vha primary care. the primary outcome is reduction in systolic blood pressure from baseline to follow-up at 1-year. secondary outcomes include a reduction in framingham cardiovascular risk score, individual cardiovascular risks (tobacco use, lipids), health related quality of life, and health care use. the investigators will also assess the effects of the peer health coach intervention on intermediate outcomes including social support, patient activation, patient/provider communication and health behaviors (e.g. medication adherence, physical activity, nutrition, alcohol use, and stress management). the cost of the intervention will be assessed to inform feasibility for future studies, determine veteran and staff satisfaction with the intervention, and identify barriers and facilitators to adoption. note, the intermediate outcomes were not prespecified in the protocol for evaluation and were not specified in the grant, protocol paper, or in our sap as outcomes and were removed from results analysis.

Eligibility criteria:
inclusion criteria: * must be a veteran * have \> 1 visit to va puget sound health care center(seattle or american lake va) primary care or women's clinic in the past year * poorly controlled hypertension (\> 150/90 mmhg) * at least one other cvd risk (including overweight or obesity, body mass index \> 25 kg/m2, tobacco use, hyperlipidemia ldl-c \> 130 mg/dl) exclusion criteria: * hospitalization in the past 3 months for cardiovascular-related conditions (ihd, cerebral vascular accident \[cva\], pvd) * severe illness that precludes lifestyle program, end-stage renal disease (esrd) on dialysis * nursing home resident, homeless * severe cognitive impairment * receiving home-based primary care (including va home tele-health and patients who received palliative care or are enrolled in hospice care)

Keywords: smoking (tobacco use) peer health coach systolic blood pressure framingham cardiovascular risk score lipid health related quality of life health care utilization medication adherence physical activity nutrition alcohol use stress management