Abstract 19901: Abnormal Carotid Screening is Associated with Motivation to Improve Lifestyle and Medical Follow-up
Background: Non-adherence to medical therapy and follow-up is associated with worse cardiovascular disease (CVD) outcomes yet contributing factors are not fully defined.
Purpose: To establish the rate of follow-up of abnormal carotid screening results, motivation to change lifestyle, and barriers to adherence to preventive therapy.
Methods: This was a 1 year prospective study of men >40 yrs and women >50 yrs (mean age 60 yrs, 60% female, 56% non-white), or with established CVD or equivalent who completed a standardized CVD evaluation and a 1yr questionnaire (n=265, 71% follow-up rate). Screening included medical history, medication adherence, blood pressure (BP), lipids, and abbreviated carotid artery ultrasound to determine presence/absence of plaque. Medication non-adherence was defined as missing any pills for abnormal BP or cholesterol in the past week. Participants with abnormal results were briefly educated and systematically referred for follow-up.
Results: Among participants with carotid plaque (n=197) referred for evaluation, 79% reported following up with a healthcare provider by 1yr and 36% reported having a follow-up carotid artery scan by 1yr. Participants with plaque were significantly more likely to see a healthcare provider by 1yr than those without, independent of age, gender, race/ethnicity, CVD, and other factors (OR=2.1, 95%CI=1.1-3.9, p=0.02). At 1yr, 37% of participants with abnormal carotid results reported that learning they might have clogged arteries motivated them to improve their lifestyle habits a lot, 27% a little, and 7% not at all. Among participants who were undiagnosed and unaware that they had elevated BP or cholesterol at baseline (n=43), 56% saw a healthcare provider by 1yr. Participants who reported non-adherence to BP or cholesterol pills at baseline (42%) cited side effects (52%) and safety of medications (28%) as the most common barriers to adherence at 1yr.
Conclusions: Presence of plaque on a brief screening carotid ultrasound was associated with motivation to improve lifestyle and medical follow-up at 1yr. The data also document that concerns about side effects and safety of preventive medications were common barriers to adherence, underscoring the potential for education to improve clinical outcomes.
- © 2010 by American Heart Association, Inc.