Heart Disease Self-management for African American Older Adults: Outcomes of an Adapted Evidence-Based Intervention

Abstract

Background and Objectives: To assess the impact of an evidence-based self-management intervention adapted through a community-engaged process for African American midlife and older adults with heart disease and/or cardiovascular risk factors. Research Design and Methods: Adults 50 years and over, living in or near Detroit, MI, with diagnosed heart disease or greater or equal to two major risk factors for heart disease, were randomized to a 7-week group-format program called Take Heart, or a usual-care control group. Take Heart included education about heart disease and support for behavioral lifestyle change, using a goal-setting process based on self-regulation theory. Outcome data were collected via telephone surveys at baseline and 1 year from baseline. Primary outcomes were self-reported emergency department visits and hospitalizations in the last year. Secondary outcomes were health-related quality of life (PROMIS-29 Adult Profile) and cardiac symptom burden. Results: A total of 453 participants enrolled (74% female, 84% African American, mean age 65.4 years; 55% with diagnosed heart disease and 45% with risk factors only); 362 provided baseline and follow-up data. Using generalized linear and binomial regression models, at 12-month follow-up, there were no significant differences between intervention and control groups in ED visits or hospitalizations. Intervention versus control participants had greater improvements in PROMIS fatigue (p =. 003) and sleep (p =. 04) subscales as well as cardiac symptom burden (p =. 04). Discussion and Implications: The Take Heart intervention was associated with modest improvements in sleep, fatigue, and cardiac symptom burden. Take Heart was well received and has potential for dissemination by agencies serving older adults. Clinical Trial Registration Number: https://www.clinicaltrials.gov/ct2/show/NCT02950818