Lead/Presenter: Karin Nelson, COIN - Seattle/Denver
All Authors: Nelson KM (VA Puget Sound Health Care System), Rao M (VA Puget Sound Health Care System) Taylor LL (VA Puget Sound Health Care System) Williams JL(VA Puget Sound Health Care System) Epler EM (VA Puget Sound Health Care System) Fennell TJ (VA Puget Sound Health Care System)
Objectives:
Although cardiovascular disease (CVD) is a leading cause of mortality, CVD risk factors remain sub-optimally controlled. We tested the effectiveness of a peer health coach intervention among Veterans with hypertension and other CVD risks.
Methods:
Patients enrolled at the VA Puget Sound with diagnosis of hypertension, at least one blood pressure >150/90 mmHg in the past year, and one other CVD risk (current smoker, overweight/obesity, or a diagnosis of hyperlipidemia) were randomized to a 12-month peer health coach intervention versus usual care. Coaching sessions were initially home-based, but intervention protocols were modified to virtual delivery during the COVID-19 pandemic. The primary outcome was change in systolic blood pressure (SBP) from baseline enrollment to 12 months; secondary outcomes included health-related quality of life (HQOL) as measured using the SF-12 mental health (MCS) and physical health (PCS) composite score, and cardiovascular risk (measured by the Framingham Risk Score). We used an intention to treat analysis, modeling changes in outcome with mixed effects models that controlled for clustering by physician and peer health coach and using multiple imputation for outcomes with more than 15% missing.
Results:
Of the 264 participants, 229 were men (87%), 129 were white (49%), 74 were Black (28%), and 36 were multi-racial (14%). Participants reported low income ( < 40K per year, n = 117, 44%). The mean SBP was 136 mmHg. By hypertension stage, 15% (n = 39) had elevated blood pressure, 44% (n = 117) had stage 1 hypertension, and 25% (n = 66) had stage 2 hypertension or above. We found no significant change in SBP between the intervention group (n = 134) and control group (n = 130) (unadjusted mean change of -3.21 and -0.52, respectively; adjusted difference of -1.96 mmHg). We found a significant improvement in the MCS in the intervention group compared to the usual care group (adjusted mean change of +2.19 and -1.01 respectively; adjusted difference of +3.6), but no difference in PCS scores or CVD risk.
Implications:
While the peer health coaching program did not significantly decrease systolic blood pressure or cardiovascular risk, Veterans in the treatment arm reported higher mental health related quality of life.
Impacts:
Peer health coaching could be incorporated into care delivery to improve mental health related quality of life among Veterans with hypertension.