The effect of patient training of the fundamentals of medical knowledge on the effectiveness of controlling cardiovascular risk factors
Authors: Isayeva G.S , Vovchenko M , Buriakovska O , Shalimova A , Emelyanova N 
Published: November 2020

Abstract

A prospective randomized parallel-group study was performed to assess the effectiveness of group and individual educational training of patients of the fundamentals of medical knowledge to control risk factors. The study included 365 patients with high and very high cardiovascular risk; 150 had group training; 150 had individual training; 65 were a control group, follow-up period was 3 years. Blood pressure, body mass index (BMI), fat to muscle ratio (bioimpedance method, Body Composition Monitor BF511), physical activity (Walking style III pedometer), blood lipids, glucose, glycosylated hemoglobin, quality of life (SF-36 Health Status Survey questionnaire), eating habits, and compliance to medical therapy (Morisky-Green questionnaire) were evaluated before and after completion of the training. The composite endpoint was assessed (myocardial infarction, stroke, cardiovascular death, hospitalizations due to worsening of heart failure, urgent revascularization). Educational hours were the same in both groups, but in the “Individual group” patients had “face to face” visits with a medical specialists. All patients kept an individual diary. Statistical processing was performed using the SPSS 17 (IBM) package.

Results
In both training groups, a significant decrease in blood pressure and an increase of patients with the target blood pressure were found. After completing the educational course, the level of compliance to drug treatment in the “group training” had scored of 3.2 [1.5–3.5]; 3.5 [2.5–3.75] in the “individual training” group, and 2.0 [1.0–3.0] in the control group. Initially, the number of patients with the targeted blood pressure level was 63 (42.0%) and 67 (44.6%) persons in the “group training” and “individual training” groups; this parameter after training completion was 134 (89.3%, p=0.0001) in “group training” and 121 (80.6%, p=0.0001) in “individual training”. Patients undergoing “group training” did not have their blood lipids changed significantly. In the course of “individual training”, statistically significant decreases in total cholesterol by 21.1% (p=0.031), LDL cholesterol by 20.1% (p=0.04) and an increase in HDL cholesterol by 11% (p=0.03) were observed. A significant decrease in BMI (by 7.1%, p=0.011) and fat tissue content (10.2%, p=0.013) were observed only after “individual training”. Eating habits and smoking rate did not change significantly in the groups. An increase in physical activity was detected only in “individual training” group. Risk of cardiovascular events was lower “individual training” group (OR-0,32; CI 95% 0,12–0,84; p=0,02).

Conclusion
Both individual and group educational courses did not lead to a change in eating habits, but had significant effect on blood pressure. More significant effect of individual training compared to group training was found on blood lipids, physical activity and quality of life. A decrease in cardiovascular events was noted only in the “individual training” group.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): L.T. Mala National Institute of Therapy NAMSU