AHA statement: Behavioral interventions are best preventive means for heart risk

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Combining counseling and extended follow-up with a healthcare provider and self-monitoring of diet and exercise is the most effective way to help patients embrace lifestyle changes that can lower their risk for cardiovascular diseases, according to a scientific statement published in July in Circulation.

Current healthcare policies should be modified to encourage these interventions, the authors said.

“We need to do a better job finding ways to help people not only change their behaviors, but maintain them over a lifetime,” said lead author Nancy T. Artinian, PhD, RN, an associate dean for research and director of the Center for Health Research at Wayne State University College of Nursing in Detroit.

The statement is based on a review of peer-reviewed scientific studies. Artinian and her co-authors identified several critical parts of effective behavioral change programs, including healthcare providers using a motivational interviewing technique to encourage patients to make healthier lifestyle choices, counseling patients that occasional setbacks are normal and scheduling recurring follow-up sessions with patients.

The most effective patient-controlled behaviors include setting specific goals for physical activity and dietary improvements, and keeping track of progress towards those goals, Artinian said.

She and her co-authors analyzed 74 studies conducted among U.S. adults between January 1997 and May 2007. The studies measured the effects of behavioral change on blood pressure and cholesterol levels; physical activity and aerobic fitness; and diet, including reduced calorie, fat, cholesterol and salt intake, and increased fruit, vegetable and fiber consumption.

According to American Heart Association (AHA) statistics, about 81.1 million adults, or one out of every three people in America, have at least one type of cardiovascular disease, such as heart attack, stroke or heart failure. If cardiovascular diseases were completely eradicated, life expectancy could increase by nearly seven years.

“Lifestyle change is never easy and often under-emphasized in clinical encounters with our patients. This statement shows what types of programs work and supports the increased need for counseling and goal setting to improve healthy cardiovascular habits,” said Ralph Sacco, MD, AHA’s president. “We need to find more effective ways to make lifestyle change programs available, especially to the groups at highest risk for cardiovascular diseases—older Americans, African-Americans and people of Hispanic origin.”

Although obesity, physical inactivity and poor diet are well recognized as major risk factors for cardiovascular disease, it’s often difficult for doctors and nurses to help patients reduce their risk for an extended period. They are faced with numerous obstacles, including time constraints, reimbursement problems and insufficient training in behavioral-change techniques, the statement authors wrote.

Despite these difficulties, Artinian said policy changes will eventually make critical interventions more readily available.

“I’m looking forward to the future when we will have a healthcare system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk,” Artinian said.