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The Design and Implementation of a Heart Disease Reversal Program in the Veterans Health Administration: Before and
Themis A Yiaslas1, Ajay Sood1, Gregory Ono1
1is a Psychologist in the Behavioral Medicine Clinic; is Chief, Endocrine Section; and are Clinical Pharmacists; , and are Dietitians, Nutrition and Food Service; is a Nurse Educator; all at the Sacramento Veterans Affairs Medical Center in California. is a Psychologist, Behavioral Medicine Service, Kaiser Permanente, in Sacramento. Themis Yiaslas is an Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Ajay Sood is Professor, Division of Endocrinology; and is a Professor and Director of Medical Student Research; all at the University of California Davis School of Medicine in Sacramento.
Insights
The Heart Disease Reversal Program (HDRP) offers veterans a novel lifestyle intervention to reduce cardiovascular disease (CVD) risk. This program shows high patient acceptability and demonstrates the value of disease reversal in healthcare.
Area of Science:
- Cardiovascular disease research
- Lifestyle medicine
- Health services research
Background:
- Cardiovascular disease (CVD) is the leading cause of death in the US, with rising prevalence.
- Military veterans have a higher risk of CVD compared to non-veterans.
- Many veterans in the Veterans Health Administration (VA) have multimorbidity (≥ 2 chronic diseases).
Purpose of the Study:
- To introduce the Heart Disease Reversal Program (HDRP), a novel lifestyle intervention for veterans.
- To adapt and implement the HDRP within a VA setting, including telehealth delivery.
- To assess patient acceptability and the effectiveness of direct-to-patient outreach for launching the program.
Main Methods:
- The HDRP is an interdisciplinary, multicomponent lifestyle program.
- It is a streamlined adaptation of behavioral interventions for atherosclerotic heart disease regression and cardiovascular risk reduction.
- The program was developed and implemented in a VA behavioral medicine clinic and adapted for videoconferencing.
Main Results:
- Patient satisfaction surveys indicated a very high level of acceptability for the HDRP.
- Direct-to-patient clinical outreach proved effective for program launch.
- The program was successfully adapted for telehealth delivery during the COVID-19 pandemic.
Conclusions:
- The HDRP offers significant clinical benefits to patients by promoting disease reversal.
- Implementing disease reversal interventions adds value to the healthcare system.
- Reversing disease represents a high aim for medicine and healthcare professionals.
Background:
Heart disease continues to be the leading cause of death in the US, and the number of people with cardiovascular disease (CVD) is rising. CVD is more prevalent among military veterans than nonveterans, and veteran status is associated with higher risk of incident heart disease after controlling for socioeconomic status, other medical diseases, depression, and lifestyle. Many patients seeking care in the Veterans Health Administration, including those who undergo cardiac catheterization, meet the criteria for multimorbidity (defined as ≥ 2 chronic diseases).
Observations:
The Heart Disease Reversal Program (HDRP) is a novel interdisciplinary, multicomponent lifestyle program at the US Department of Veterans Affairs (VA) Sacramento VA Medical Center. This program is a streamlined adaptation of behavioral/lifestyle interventions aimed at promoting partial reversal (regression) of atherosclerotic heart disease and achievement of comprehensive cardiovascular risk reduction. HDRP was developed and implemented within a VA behavioral medicine clinic and successfully adapted for delivery through videoconferencing during the COVID-19 pandemic. Patient satisfaction survey data indicate a very high level of patient acceptability. We found direct-to-patient clinical outreach an effective method for launching a disease reversal program.
Conclusions:
Beyond the clinical benefits to patients, there is significant value and benefit added to the health care system by offering an intervention within the disease reversal paradigm. Efforts of the health care team to reverse a disease can be considered the highest aim of medicine and health care.
