TY - JOUR
T1 - Closing Gaps in Lifestyle Adherence for Secondary Prevention of Coronary Heart Disease
AU - Aggarwal, Monica
AU - Ornish, Dean
AU - Josephson, Richard
AU - Brown, Todd M.
AU - Ostfeld, Robert J.
AU - Gordon, Neil
AU - Madan, Shivank
AU - Allen, Kathleen
AU - Khetan, Aditya
AU - Mahmoud, Ahmed
AU - Freeman, Andrew M.
AU - Aspry, Karen
N1 - Publisher Copyright:
© 2021
PY - 2021/4/15
Y1 - 2021/4/15
N2 - The secondary prevention (SP) of coronary heart disease (CHD) has become a major public health and economic burden worldwide. In the United States, the prevalence of CHD has risen to 18 million, the incidence of recurrent myocardial infarctions (MI) remains high, and related healthcare costs are projected to double by 2035. In the last decade, practice guidelines and performance measures for the SP of CHD have increasingly emphasized evidence-based lifestyle (LS) interventions, including healthy dietary patterns, regular exercise, smoking cessation, weight management, depression screening, and enrollment in cardiac rehabilitation. However, data show large gaps in adherence to healthy LS behaviors and low rates of enrollment in cardiac rehabilitation in patients with established CHD. These gaps may be related, since behavior change interventions have not been well integrated into traditional ambulatory care models in the United States. The chronic care model, an evidence-based practice framework that incorporates clinical decision support, self-management support, team-care delivery and other strategies for delivering chronic care is well suited for both chronic CHD management and prevention interventions, including those related to behavior change. This article reviews the evidence base for LS interventions for the SP of CHD, discusses current gaps in adherence, and presents strategies for closing these gaps via evidence-based and emerging interventions that are conceptually aligned with the elements of the chronic care model.
AB - The secondary prevention (SP) of coronary heart disease (CHD) has become a major public health and economic burden worldwide. In the United States, the prevalence of CHD has risen to 18 million, the incidence of recurrent myocardial infarctions (MI) remains high, and related healthcare costs are projected to double by 2035. In the last decade, practice guidelines and performance measures for the SP of CHD have increasingly emphasized evidence-based lifestyle (LS) interventions, including healthy dietary patterns, regular exercise, smoking cessation, weight management, depression screening, and enrollment in cardiac rehabilitation. However, data show large gaps in adherence to healthy LS behaviors and low rates of enrollment in cardiac rehabilitation in patients with established CHD. These gaps may be related, since behavior change interventions have not been well integrated into traditional ambulatory care models in the United States. The chronic care model, an evidence-based practice framework that incorporates clinical decision support, self-management support, team-care delivery and other strategies for delivering chronic care is well suited for both chronic CHD management and prevention interventions, including those related to behavior change. This article reviews the evidence base for LS interventions for the SP of CHD, discusses current gaps in adherence, and presents strategies for closing these gaps via evidence-based and emerging interventions that are conceptually aligned with the elements of the chronic care model.
UR - http://www.scopus.com/inward/record.url?scp=85101160913&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101160913&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2021.01.005
DO - 10.1016/j.amjcard.2021.01.005
M3 - Article
C2 - 33454343
AN - SCOPUS:85101160913
SN - 0002-9149
VL - 145
SP - 1
EP - 11
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -