Recruitment, Retention, and Future Direction for a Heart Health Education and Risk Reduction Intervention Led by Community Health Workers in an African American Majority City

Heart disease is a leading cause of death for African Americans. A community-academic partnership cross-trained community health workers to engage African American adults in a 6-month heart health education and risk reduction intervention. We conducted a one-group feasibility study using a one group (pre-posttest) design. A total of 100 adults were recruited from 27 zip codes in an African American majority city through community-based organizations (46%), churches (36%), and home visits (12%). Ninety-six percent were African American; 55% were female, 39% were male, and 6% were transgender. Their mean age was 44.6 years (SD=15.9). Ninety-two percent had health insurance. Seventy-six percent of participants averaged blood pressure (BP) readings\u3e130/80 mmHg. Eleven percent of participants had a 30% or higher probability of developing cardiovascular disease in the next 10 years. Six-month follow-up was completed with 96% of participants. There were statistically significant increases in knowledge and in perception of personal risk for heart disease. However, slightly more participants (n=77, 80.2%) had BP\u3e130/80 mmHg. The Community Advisory Group recommended expanding the intervention to 12 months and incorporating telehealth with home BP monitoring. Limited intervention duration did not meet longer term objectives such as better control of high BP and sharing risk reduction planning with primary care providers

Study of adherence to exercise in heart failure: the HEART camp trial protocol

Background: Adherence to the Heart Failure Society of America (HFSA) 2010 guidelines recommending 30 minutes of supervised moderate intensity exercise five days per week is difficult for patients with heart failure (HF). Innovative programs are needed to assist HF patients to adhere to long-term exercise. The objective of this prospective randomized two-group repeated measures experimental design is to determine the efficacy of a behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with heart failure. Methods/Design: A sample size of 246 subjects with heart failure will be recruited over a 3 year period. All subjects receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to randomization. Subjects completing at least 6 of 9 training sessions are randomized to the HEART Camp Intervention group (HC) or to a standard care (SC) exercise group. The HC intervention group receives cognitive-behavioral strategies that address the intervention components of knowledge, attitudes, self-efficacy, behavioral self-management skills and social support. The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period. The primary aim is to evaluate the effect of HEART Camp on adherence to exercise, with our central hypothesis that the HC group will have significantly better adherence to exercise at 18 months. Secondary aims include evaluating which components of the HEART Camp intervention mediate the effects of the intervention on adherence; evaluating the effect of HEART Camp on specific health outcomes; exploring selected demographic variables (race, gender, age) as potential moderators of the effect of the HEART Camp intervention on adherence; and exploring the perceptions and experiences that contextualize exercise adherence. Discussion: The HEART Camp intervention is the first to test a multi-component intervention designed to improve long-term adherence to exercise behavior in patients with HF. Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness

The role of stress and social support in predicting depression among a hypertensive African American sample.

OBJECTIVE: We examined social support, stress, and selected demographic variables as predictors of depression among African Americans with hypertension. METHODS: Archival data collected on 194 hypertensive African Americans ranging in age from 30 to 88 years (mean age = 58.3 years, standard deviation = 12.2; 63% were female) were analyzed in the present study. Hierarchic regression analyses were conducted using two models of depression. The first model included basic demographic characteristics of the sample, including age, sex, educational attainment, income, and employment status. In the second model, the psychosocial variables of stress and social support were added to determine their predictive value. RESULTS: The first model accounted for 14% of the variance in depression and identified sex and age as significant predictors. The second model, in which two psychosocial variables were added, accounted for 45.2% of the total variance, with age, stress, and social support as significant predictors. CONCLUSIONS: Stress and social support are significant predictors of depression in a hypertensive African American population, beyond the influence of various demographic variables. These results have implications for prevention and intervention strategies with the target population

Depression, Stress, and Blood Pressure in Urban African-American Women

African-American women have disturbingly high rates of hypertension, exceeding those of African-American men and other ethnic groups. Reasons for these disparities are not understood. Depression, more common in women than men, has been linked to endothelial dysfunction, inflammation, metabolic and hematologic abnormalities, and increased sympathetic nervous system activity--all factors associated with cardiovascular disease. A descriptive correlational design was used to test the following hypotheses: 1) African-American women with higher levels of depression will have higher blood pressure (BP) levels, more cardiovascular risk factors, greater stress, and lower social support; and 2) depression will mediate the relationship between stress and BP. A convenience sample of 245 hypertensive African-American women (mean age, 61+/-12.7 years) was recruited through free BP screenings offered in the community. All data were collected during a structured interview and brief physical examination. Pearson r correlation coefficients, analysis of variance, and multiple regression analyses were used to analyze the hypotheses. Women with higher levels of depression had higher diastolic BP and were more likely to smoke, eat fewer fruits and vegetables, and have more stress and less social support. Depression mediated the relationship between stress and diastolic BP. The findings emphasize the importance of assessing both behavioral and psychosocial factors in urban African-American women with hypertension

Accelerometer-Measured Daily Activity Levels and Related Factors in Patients With Heart Failure

BACKGROUND: Few studies report objective accelerometer-measured daily physical activity levels in patients with heart failure (HF). OBJECTIVE: We examined baseline accelerometer-measured physical activity from the Heart Failure Exercise and Resistance Training Camp trial, a federally funded (R01-HL112979) 18-month intervention study to promote adherence to exercise in patients with HF. Factors associated with physical activity levels were also explored. METHODS: Patients with diagnosed HF (stage C chronic HF confirmed by echocardiography and clinical evaluation) were recruited from 2 urban medical centers. Physical activity energy expenditure and the number of minutes of moderate or vigorous physical activity (MVPA) were obtained from 7 full days of measurement with the accelerometer (Actigraph Model GT3X, Pensacola, Florida) for 182 subjects who met minimum valid wear time parameters. Additional measures of health-related factors were included to explore the association with physical activity levels. RESULTS: Subjects had 10.2 ± 10.5 minutes of MVPA per day. Total physical activity energy expenditure was 304 ± 173 kcal on average per day. There were 23 individuals (12.6%) who met the recommended goal of 150 minutes of MVPA per week. Men, whites, New York Heart Association class II, and subjects with better physical function had significantly higher levels of activity. CONCLUSIONS: Consistent with previous research, patients with HF are not meeting recommended guidelines for 150 minutes of MVPA per week

Effects of the HEART Camp Trial on Adherence to Exercise in Patients With Heart Failure

BACKGROUND: Few exercise training studies in patients with heart failure (HF) report adherence to guideline-recommended 150 minutes of moderate-intensity exercise per week, and no studies have focused on a primary outcome of adherence. METHODS AND RESULTS: This randomized controlled trial evaluated the effect of a multicomponent intervention, Heart Failure Exercise and Resistance Training (HEART) Camp, on adherence to exercise (after 6, 12, and 18 months) compared with an enhanced usual care (EUC) group. Patients (n = 204) were 55.4% male, overall average age was 60.4 years, and 47.5% were nonwhite. The HEART Camp group had significantly greater adherence at 12 (42%) and 18 (35%) months compared with the EUC group (28% and 19%, respectively). No significant difference (P \u3e .05) was found at 6 months. The treatment effect did not differ based on patient\u27s age, race, gender, marital status, type of HF (preserved or reduced ejection fraction) or New York Heart Association functional class. Left ventricular ejection fraction (LVEF) significantly moderated the treatment effect, with greater adherence at higher LVEF. CONCLUSIONS: The multicomponent HEART Camp intervention showed efficacy with significant effects at 12 months and 18 months. Adherence levels remained modest, indicating a need for additional research to address methods and strategies to promote adherence to exercise in patients with HF

Urban Hypertensive African American Grandparents

Abstract available at publisher's website