| Titre : | Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile a Randomized controlled trial. (2003) |
| Auteurs : | Patrick-G O'MALLEY ; FEUERSTEIN (Irwin-M) : USA. Department of Radiology. Waiter Reed Army Medical Center. Washington. DC. ; Allen-J TAYLOR ; Department of Medicine. Waiter Reed Army Medical Center. Washington. DC. USA ; Uniformed Services University of the Health Sciences. Bethesda. MD. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 289, n° 17, 2003) |
| Pagination : | 2215-2223 |
| Langues: | Anglais |
| Mots-clés : | Appareil circulatoire [pathologie] ; Facteur risque ; Programme santé ; Dépistage ; Tomographie ; Participation ; Motivation ; Evaluation ; Homme ; Randomisation ; Radiodiagnostic |
| Résumé : | [BDSP. Notice produite par INIST-CNRS a86CvR0x. Diffusion soumise à autorisation]. Context Although the use of electron beam tomography (EBT) as a motivational tool to change behavior is practiced, its efficacy has not been studied. Objective To assess the effects of incorporating EBT as a motivational factor into a cardiovascular screening program in the context of either intensive case management (ICM) or usual care by assessing its impact over 1 year on a composite measure of projected risk. Design Randomized controlled trial with a 2 x 2 factorial design and 1 year of follow-up. Setting and Participants A consecutive sample of 450 asymptomatic active-duty US Army personnel aged 39 to 45 years stationed within the Washington, DC, area and scheduled to undergo a periodic Army-mandated physical examination were enrolled between January 1999 and March 2001 (mean age, 42 years ; 79% male ; 66 [15% ] had coronary calcification ; mean [SD] predicted 10-year coronary risk, 5.85% [3.85% ]). Interventions Patients were randomly assigned to 1 of 4 intervention arms : EBT results provided in the setting of either ICM (n=111) or usual care (n=119) or EBT results withheld in the setting of either ICM (n=124) or usual care (n=96). Main Outcome Measure The primary outcome measure was change in a composite measure of risk, the 10-year Framingham Risk Score (FRS). Results Comparing the groups who received EBT results with those who did not, the mean absolute risk change in 10-year FRS was+0.30 vs+0.36 (P=81). Comparing the groups who received ICM with those who received usual care, the mean absolute risk change in 10-year FRS was - 0.06 vs+0.74 (P=003). Improvement or stabilization of cardiovascular risk was noted in 157 patients (40.2%). In multivariable analyses predicting change in FRS, after controlling for knowledge of coronary calcification, motivation for change, and multiple psychological variables, only the number of risk factors (odds ratio, 1.42 ; 95% confidence interval, 1.16-1.75 for each additional risk factor) and receipt of ICM (odds ratio, 1.62 ; 95% confidence interval, 1.04-2.52) were associated with improved or stabilized projected risk. Conclusions Using coronary calcification screening to motivate patients to make evidence-based changes in risk factors was not associated with improvement in modifiable cardiovascular risk at 1 year. Case management was superior to usual care in the management of risk factors. |
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