Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT).
Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT).
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DOI：
10.4088/jcp.12m08082
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发表时间：
2013-07
期刊：
影响因子：
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通讯作者：
Bauer MS
中科院分区：
文献类型：
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作者：
Kilbourne AM;Goodrich DE;Lai Z;Post EP;Schumacher K;Nord KM;Bramlet M;Chermack S;Bialy D;Bauer MS
双相情感障碍患者经历了不成比例的疾病负担，特别是心血管疾病(CVD)，导致功能受损和过早死亡。该研究的目的是确定生活目标协作护理(LGCC)干预是否与加强常规护理相比，减少心血管疾病危险因素，并改善VA双相情感障碍患者的身心健康结果。在2008年4月至2010年5月进行的自我管理解决心脏风险试验中，ICD-9诊断为双相情感障碍且>；=1心血管危险因素的患者(n=118)被随机分成LGCC(N=58)或增强型常规护理(N=60)。LGCC包括每周四次自我管理会议，随后是量身定做的联系人，结合健康行为改变战略、医疗保健管理、登记跟踪和提供者指南支持。除了标准治疗外，增强的日常护理还包括在12个月内发送季度健康时事通讯。在确定参加研究的180名合格患者中，134名(74%)入选，118名完成了结果评估(平均年龄=53岁，17%为女性，5%为非裔美国人)。混合效应分析比较了长期护理组(N=57)和强化常规护理组(N=59)患者24个月结果的变化，结果显示，接受长期长期护理的患者的收缩压(β=−3.1，P=0.04)和舒张压(β=−2.1，P=0.04)以及躁狂症状(β=−23.9，P=0.01)都有所减少。LGCC对其他主要结果(总胆固醇、与身体健康相关的生活质量)没有显著影响。与加强日常护理相比，LGCC可减少心血管危险因素，特别是通过降低血压和减少躁狂症状。
Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. The study objective was to determine whether the Life Goals Collaborative Care (LGCC) intervention compared to enhanced usual care, reduced CVD risk factors and improved physical and mental health outcomes in VA patients with bipolar disorder. Patients with ICD-9 diagnosis of bipolar disorder and >=1 CVD risk factor (n=118) enrolled in the Self-Management Addressing Heart Risk Trial conducted April 2008–May 2010, were randomized to LGCC (N=58) or enhanced usual care (N=60). LGCC included four weekly self-management sessions followed by tailored contacts combining health behavior change strategies, medical care management, registry tracking, and provider guideline support. Enhanced usual care included quarterly wellness newsletters sent over a 12-month period in addition to standard treatment. Out of the 180 eligible patients identified for study participation, 134 were enrolled (74%) and 118 completed outcomes assessments (mean age = 53, 17% female, 5% African American). Mixed effects analyses comparing changes in 24-month outcomes among patients in LGCC (N=57) versus enhanced usual care (N=59) groups revealed that patients receiving LGCC had reduced systolic (Beta=−3.1, P=.04) and diastolic blood pressure (Beta=−2.1, P=.04) as well as reduced manic symptoms (Beta=−23.9, P=.01). LGCC had no significant impact on other primary outcomes (total cholesterol, physical health-related quality of life). LGCC compared to enhanced usual care may lead to reduced CVD risk factors, notably through decreased blood pressure, as well as reduced manic symptoms.