The use of virtual world-based cardiac rehabilitation to encourage healthy lifestyle choices among cardiac patients: intervention development and pilot study protocol.

BACKGROUND: Despite proven benefits through the secondary prevention of cardiovascular disease (CVD) and reduction of mortality, cardiac rehabilitation (CR) remains underutilized in cardiac patients. Underserved populations most affected by CVD including rural residents, low socioeconomic status patients, and racial/ethnic minorities have the lowest participation rates due to access barriers. Internet-and mobile-based lifestyle interventions have emerged as potential modalities to complement and increase accessibility to CR. An outpatient CR program using virtual world technology may provide an effective alternative to conventional CR by overcoming patient access limitations such as geographics, work schedule constraints, and transportation. OBJECTIVE: The objective of this paper is to describe the research protocol of a two-phased, pilot study that will assess the feasibility (Phase 1) and comparative effectiveness (Phase 2) of a virtual world-based (Second Life) CR program as an extension of a conventional CR program in achieving healthy behavioral change among post-acute coronary syndrome (ACS) and post-percutaneous coronary intervention (PCI) patients. We hypothesize that virtual world CR users will improve behaviors (physical activity, diet, and smoking) to a greater degree than conventional CR participants. METHODS: In Phase 1, we will recruit at least 10 patients enrolled in outpatient CR who were recently hospitalized for an ACS (unstable angina, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction) or who recently underwent elective PCI at Mayo Clinic Hospital, Rochester Campus in Rochester, MN with at least one modifiable, lifestyle risk factor target (sedentary lifestyle, unhealthy diet, and current smoking). Recruited patients will participate in a 12-week, virtual world health education program which will provide feedback on the feasibility, usability, and design of the intervention. During Phase 2, we will conduct a 2-arm, parallel group, single-center, randomized controlled trial (RCT). Patients will be randomized at a 1:1 ratio to adjunct virtual world-based CR with conventional CR or conventional CR only. The primary outcome is a composite including at least one of the following (1) at least 150 minutes of physical activity per week, (2) daily consumption of five or more fruits and vegetables, and (3) smoking cessation. Patients will be assessed at 3, 6, and 12 months. RESULTS: The Phase 1 feasibility study is currently open for recruitment which will be followed by the Phase 2 RCT. The anticipated completion date for the study is May 2016. CONCLUSIONS: While research on the use of virtual world technology in health programs is in its infancy, it offers unique advantages over current Web-based health interventions including social interactivity and active learning. It also increases accessibility to vulnerable populations who have higher burdens of CVD. This study will yield results on the effectiveness of a virtual world-based CR program as an innovative platform to influence healthy lifestyle behavior and self-efficacy.

Go Red for Women cardiovascular health-screening evaluation: the dichotomy between awareness and perception of cardiovascular risk in the community.

BACKGROUND: Cardiovascular (CV) disease is the leading cause of death in U.S. women. Although women are becoming more aware of CV disease, there remains a dichotomy between awareness and perceived risk. We sought to characterize this dichotomy in women attracted to a CV health-screening event, in order to improve strategies to reduce CV risk. METHODS: During CV health events held in Rochester, Minnesota, from 2007 through 2011, 294 women underwent screening for blood chemistry, body mass index, and blood pressure. Participants also completed surveys about knowledge of CV disease, risk factors, and perceived risk. Risk level was determined from the 2011 American Heart Association Effectiveness-Based Guidelines for Women. RESULTS: Among participants (age, mean [standard deviation], 53 [15.3] years; white, 98%), 99% were aware that CV disease is the leading cause of death in women. Almost half (47%) perceived themselves to be at personal risk, although 65% were determined to be "at risk" and 12% to be at "high risk" according to guidelines, while 22% were uncategorized. Of the 228 participants "at risk" or "high risk," 48% and 21%, respectively, did not perceive themselves to be at any risk. CONCLUSIONS: Women attracted to CV health events were aware that CV disease is the leading cause of death for women. However, the magnitude of awareness did not directly translate into perception or understanding of actual personal risk. To decrease the rate of CV disease in women, continued efforts are needed to personalize the importance of, and the methods for reducing, CV risk factors.

Registered nurse initiation of a tobacco intervention protocol: leading quality care.

UNLABELLED: This article summarizes the development and implementation of a registered nurse-initiated protocol to intervene with hospitalized patients who are tobacco-dependent, may be experiencing tobacco withdrawal, and who are hospitalized in a smoke-free environment. RATIONALE: Tobacco use is the leading cause of preventable death in the United States. Hospitalization provides a unique teachable moment to treat tobacco dependence. Nurses can be effective in talking with patients about tobacco use. DEVELOPMENT: The clinical nurse specialist spheres of influence model and the role of the clinical nurse specialist were important for developing a tobacco use intervention protocol. A multi-disciplinary team created key objectives. These included identifying and assessing all patients who use tobacco, providing treatment to manage both withdrawal and address tobacco dependence, providing comfort to patients while hospitalized in a tobacco-free environment, encouraging lifelong cessation. The bedside admitting nurse was chosen as the pivotal professional to trigger tobacco use interventions. IMPLEMENTATION: A protocol was finalized that requires the bedside nurse to assess all patients for past and current tobacco use. The nurse is then prompted to (1) provide information about tobacco dependence and treatment, (2) ask if the patient wants nicotine patch therapy to address withdrawal and, (3) order a consult with a specialist at the patient's request. Extensive and varied educational programs were developed to support the implementation of the protocol. OUTCOMES: The tobacco use intervention protocol has become important for providing assessment and intervention to patients who use tobacco. It has increased the number of specialist consults provided to patients. It has increased compliance with quality reporting data by national quality accrediting bodies.