Denver Health Cardiovascular Disease (CVD) Prevention Program
Condition: Cardiovascular Disease
MeSH terms: Cardiovascular Diseases
Study type: Interventional

Summary: 
      The objective of the Denver Health CVD Prevention Program is to assess the effectiveness of
      developing an enhanced cardiovascular disease prevention program in a community health care
      setting.
    

Detailed description: 
      Cardiovascular disease (CVD) is the leading cause of mortality in Colorado.[1] This is
      especially true in the Latino population who are at greater risk for CVD compared to
      non-Latino whites, and suffer more premature CVD deaths.[2] Among persons less than 34 years,
      Latinos are four times more likely to die from heart disease than non-Latino whites, a
      disparity that lessens but does not disappear with age (1.5 ratios among persons 55 - 64 yrs
      old). Recently, the INTERHEART study demonstrated that 90% of the population attributable
      risk is due to established modifiable risk factors (smoking, dyslipidemia, hypertension,
      diabetes, obesity, psychosocial factors, daily consumption of fruits and vegetables, regular
      alcohol consumption and regular physical activity).[3] Many individuals in the general
      population have one or more risk factors for CVD and over 90% of CVD events occur in
      individuals with at least one risk factor,[3, 4] with few events occurring in individuals
      with no risk factors, thus supporting the notion of focusing prevention activities on
      individuals at higher risk for CVD.

      Reducing the risk of CVD is part of Colorado's strategic plan. Programs are needed that offer
      provide enhanced patient-centered CVD prevention services using paraprofessionals and thus
      assisting health care providers (i.e., physicians, midlevels) in addressing preventive health
      care issues. Early identification of CVD risk is paramount in order to reach those who need
      the appropriate treatment. In this regard, NCEP guidelines recommend the utilization of the
      Framingham Risk Score (FRS) as the basis to identify patients with an increased 10-year risk
      for CVD events.

      Despite evidence of the effectiveness of preventive services and the development of published
      national guidelines,[5, 6] rates of delivery of preventive services remain low.[7] The most
      common barriers identified are the lack of time during the office visit, inadequate insurance
      reimbursement, patient refusal to discuss or comply with recommendations, and lack of
      physician expertise in counseling techniques.[8-12] At Denver Community Health Services
      (DCHS), a department of Denver Health (DH), an additional barrier includes socioeconomic
      issues associated with a low-income population with ethnically diverse issues. Thus,
      delivering CVD preventive services often takes a lower priority during an office visit in a
      busy clinical practice. However, proactively identifying individuals at risk of CVD and
      involving them in their own care should increase awareness of CVD risk factors and as such
      assist in reducing the burden of CVD in the community.

      Denver Public Health (DPH) in collaboration with DCHS will implement a comprehensive
      cardiovascular risk assessment and prevention treatment plan among three westside community
      health centers. In order to improve CVD risk reduction, this demonstration project will a)
      develop a CVD registry to be able to identify at risk individuals, b) engage high-risk
      patients to participate in CVD prevention activities, c) implement a series of evidence-based
      prevention strategies to be offered in the clinic and community, d) perform both process and
      outcome evaluations of this demonstration project, and e) compare biologic results (e.g.,
      FRS, lipid levels) with sites not participating in the intervention to assess the
      effectiveness of our intervention.
    

Intervention name(s): CVD risk reduction program
Intervention type(s): Behavioral
Intervention description(s): Participants will be selected through review of the DH administrative databases or by referral from their primary care provider. After completion of the forms, the navigator and client will discuss potential CVD risk reduction activities and programs available through this program for the client to participate in. Potential activities will include self-monitoring using self-help tools,healthy nutrition and exercise activities, community-based exercise programs using the recreation centers in the community, and referral to the Colorado Quitline for smoking cessation activities. Follow-up questionnaires will be completed at 6 and 12 months after enrollment to assess changes in levels of exercise, dietary patterns, and beliefs and attitudes about behavioral change.
Other intervention name(s): CDPHE, CCPD grants programs.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Cardiovascular Disease Prevention; Behavior change; Risk Reduction