Peer Health Coaching Intervention Shows No Improvement in Blood Pressure Control

Karin M. Nelson, MD

Credit: LinkedIn

New research suggests a peer health coaching intervention was associated with significant improvements in mental health-related quality of life (HRQOL), but not systolic blood pressure (SBP), among patients with multiple risk factors for cardiovascular disease (CVD).¹

The findings from the Veteran Peer Coaches Optimizing and Advancing Cardiac Health (Vet-COACH) clinical trial were consistent with other peer-support studies that reported benefits in quality of life, suggesting peer health coaching could create opportunities for well-being improvements beyond blood pressure control.

“Among veterans, the peer support model may be especially effective due to the shared military experience and camaraderie of veterans,” wrote the investigative team, led by Karin M. Nelson, MD, from the VA Puget Sound Health Care System. “Providing social support via veteran peer health coaches of similar socioeconomic and military backgrounds who live in the same neighborhoods may be one model that can improve patient HRQOL.”

Although CVD remains the leading cause of death in the United States, risk factors remain suboptimally controlled in the US population and among veterans who seek care from the Veterans Health Administration (VHA). Nearly half of these veterans have a diagnosis of hypertension and one-quarter have poor blood pressure control, according to previous findings.² Management of CV risks is often a complex process that requires self-monitoring, medication use, diet, and physical activity, and working with health care clinicians.

For the current analysis, the Vet-COACH trial aimed to test the effectiveness of a home-visit, peer health coaching intervention to improve health outcomes for veterans with multiple CVD risks using a neighborhood-based recruitment strategy. The trial was conducted from May 2017 - October 2021 among veterans with a diagnosis of hypertension, ≥1 blood pressure measurement of 150/90 mmHg in the preceding 12 months, and 1 other self-reported CVD risk factor (current smoking, overweight or obesity, and/or hyperlipidemia diagnosis). Eligible participants were enrolled at the Seattle or American Lake VHA primary care clinicians in Washington state and investigators recruited both peer health coaches and participants who lived in Census tracts with the highest rates of hypertension.

After collecting baseline data collection, participants were randomized to receive either a home-based peer-support intervention for 12 months or usual care. A total of 7 peer health coaches assessed blood pressure control, provided social support, targeted health education, assisted participants with health goal setting, and linked participants to clinic and community-based resources. Those in the control group received usual medical care and the same educational materials provided to the intervention group.

Overall, 264 participants were randomized to the intervention group (n = 134) or to the control group (n = 130), with 103 (44%) reporting low annual income (<$40,000). The population had a mean age of 60.6 years and consisted of 229 males (87%); 73 (28%) patients self-identified as non-Hispanic Black and 123 (47%) self-identified as non-Hispanic White. The mean SBP was 136 mmHg at baseline and overall cardiovascular risk was high, as measured by the Framingham Risk score (mean risk in next 10 years, 24%).

Regarding the primary outcome, the analysis showed no significant difference in SBP change between the intervention and control groups (-3.32 mmHg [95% CI, -6.88 to 0.23] vs. -0.40 mmHg [95% CI, -4.20 to 3.39]; adjusted difference, -2.05 [95% CI, -7.00 to 2.55]; P = .40). Investigators additionally noted no difference in blood pressure control by the number of peer health coach visits received.

The analysis further measured the change in HRQOL using the 12-item Short Form survey (SF-12), which reflects general health status and leads to 2 scores: Physical Component Summary (PCS) and Mental Component Summary (MCS). The survey included questions about impact on emotions, ability to function, pain interfering with work, energy level, calmness, and depression.

Investigators found a significant improvement in the change in HRQOL MCS scores in the intervention vs. control group (2.19 points [95% CI, 0.26 - 4.12] vs. -1.01 points [95% CI, -2.91 to 0.88]; adjusted difference, 3.64 points [95% CI, 0.66 - 6.63]; P = .02). No differences in the PCS scores, Framingham Risk scores, and individual cardiovascular risks or health care use were noted in the analysis.

“The difference of 3.64 points exceeded the minimally important difference (ie, smallest change in an outcome that a patient would identify as important) of 3 for the SF-12 MCS score, suggesting that changes observed in the intervention group have meaningful implications for veterans,” investigators wrote.

References

1. Nelson KM, Taylor L, Williams JL, et al. 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;6(6):e2317046. doi:10.1001/jamanetworkopen.2023.17046
2. Vimalananda VG, Miller DR, Christiansen CL, Wang W, Tremblay P, Fincke BG. Cardiovascular disease risk factors among women veterans at VA medical facilities. J Gen Intern Med. 2013;28(suppl 2):S517-S523. doi:10.1007/s11606-013-2381-9