SEATTLE — Cardiovascular disease (CVD) is the leading cause of death in the United States, but CVD risk factors remain suboptimally controlled in the VHA and elsewhere.
That’s why the VA Puget Healthcare System and colleagues sought to test the effectiveness of a home-visit, peer health coaching intervention to improve health outcomes for veterans with multiple CVD risks. Results were reported in JAMA Network Open.1
The researchers conducted a two-group, unblinded randomized clinical trial, called Vet-COACH (Veteran Peer Coaches Optimizing and Advancing Cardiac Health). The trial, used a novel geographic-based method to recruit a racially diverse population of low-income veterans, all of whom were enrolled at the Seattle or American Lake, WA, VHA Health Affairs primary care clinics. Eligible to participate were veterans with a diagnosis of hypertension with at least one blood pressure reading of 150/90 mm Hg or higher in the past year, and one other CVD risk factor, such as being a current smoker, being overweight or obesity and/or hyperlipidemia; the veterans also had to live in census tracts with the highest prevalence of hypertension. Analysis was performed from May 2017 to October 2021.
The 264 participants who were randomized has a mean age of 60.6, were 87% male, 28% of Black race and 44% low income.
Participants in the intervention group received guidance from seven peer coaches for 12 months with mandatory and optional educational materials, an automatic blood pressure monitor, a scale, a pill organizer and healthy nutrition tools. Those in the control group received usual care, plus educational materials.
Defined as the primary outcome was a change in systolic blood pressure (SBP) from baseline to 12-month follow-up; secondary outcomes included change in health-related quality of life (HRQOL; measured using the 12-item Short Form survey’s Mental Component Summary and Physical Component Summary scores), Framingham Risk Score and overall CVD risk and healthcare use, including hospitalizations, emergency department visits and outpatient visits).
Results indicated no difference in change in SBP between the intervention and control groups (-3.32 [95% CI, -6.88 to 0.23] mm Hg vs. -0.40 [95% CI, -4.20 to 3.39] mm Hg; adjusted difference in differences, -2.05 [95% CI, -7.00 to 2.55] mm Hg; P = 0.40).
Participants in the intervention vs control group reported greater improvements in mental HRQOL scores (2.19 [95% CI, 0.26-4.12] points vs. -1.01 [95% CI, -2.91 to 0.88] points; adjusted difference in differences, 3.64 [95% CI, 0.66-6.63] points; P = 0.02), however. No difference was found in physical HRQOL scores, Framingham Risk Scores, and overall CVD risk or healthcare use, according to the report.
“This trial found that, although the peer health coaching program did not significantly decrease SBP, participants who received the intervention reported better mental HRQOL compared with the control group,” the authors concluded. “The results suggest that a peer-support model that is integrated into primary care can create opportunities for well-being improvements beyond blood pressure control.”
- Nelson KM, Taylor L, Williams JL, Rao M, Gray KE, Kramer CB, Epler E, Fennell T. Effect of a Peer Health Coaching Intervention on Clinical Outcomes Among US Veterans With Cardiovascular Risks: The Vet-COACH Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2317046. doi: 10.1001/jamanetworkopen.2023.17046. PMID: 37278999; PMCID: PMC10245194.