Short-term incentives for exercise can lead to sustained increases in activity

NIH-supported study shows certain perks can spur long-term behavior change in adults with cardiovascular disease risks

NIH/NATIONAL HEART, LUNG AND BLOOD INSTITUTE

Short-term incentives for exercise can lead to sustained increases in activity
NIH-supported study shows certain perks can spur long-term behavior change in adults with cardiovascular disease risks
  
Adults with heart disease risks who received daily reminders or incentives to become more active increased their daily steps by more than 1,500 after a year, and many were still sticking with their new habit six months later, according to a study supported by the National Institutes of Health that published in Circulation. The findings were simultaneously presented as late-breaking research at the American College of Cardiology’s Annual Session.

The improvements, which also resulted in an extra 40 minutes of moderate exercise each week, correlated with a 6% reduced risk of premature death and a 10% reduced risk of cardiovascular-related deaths, compared to data from prior studies. The Department of Health and Human Services recommends that most adults should get at least 150 minutes of moderate aerobic exercise per week, such as brisk walking, or 75 minutes of vigorous exercise, like fast cycling, or a combination of the two, paired with twice-weekly strength sessions.

Researchers found that while a simple daily reminder was effective in helping people move more, offering financial incentives or point-based rewards, such as in a game, was even more effective. However, combining the two incentives proved most effective. Participants who got both were still logging improvements in activity levels six months after the rewards stopped.  

“Even moderate exercise can drastically reduce cardiovascular risk, so finding low-cost ways to get people moving and stay in a fitness program that they can do at home is a huge win for public health,” said Alison Brown, Ph.D., R.D., a program officer at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

The study took place between 2019 and 2024. Researchers followed more than 1,000 adults at elevated risk for major cardiovascular events. All participants received a wearable fitness tracker, which connected to an online health portal and enabled researchers to count their baseline daily step count. Participants then set a goal to increase their daily steps by 33%, 40%, 50%, or any amount greater than 1,500 steps from their starting point. After they set their goals, participants were randomized into one of four groups.

Three groups offered incentives, including game-like rewards, financial rewards, or a combination of the two. In the game group, each participant received points every week and kept them by meeting their daily step goals. On days they failed to meet their goals they lost points. Participants with enough points moved up a level and participants who failed to meet goals moved down a level. A family member or friend could act as a participant’s “support crew” and receive weekly updates about their progress. At the end of the study, adults who reached the highest levels by meeting their daily step goals received trophies. In the financial group, each participant received $14 each week, but lost $2 a day if they did not meet their step targets. The third group received game-like and financial incentives.

The fourth group – a control group – received no incentives but got the fitness tracker, along with daily messages that noted their step count. Each intervention lasted for 12 months followed by a six-month follow-up period where all participants received the same information as controls.

Before the study began, participants in all groups logged an average of about 5,000 daily steps, or 2.4 miles. After 12 months, they increased their daily step count by more than 1,500, or three-fourths of a mile.

Compared to the control group, the game-incentive group walked an extra 538 steps from their baseline amount, while those who received financial incentives walked an extra 492. The group who received both incentives averaged 868 extra steps and maintained an average 576 more daily steps six months later. Adults in the single interventions kept their physical activity increases, but the gains didn’t differ significantly from the average 1,200 extra steps people in the control group took 18 months after the start of the study.

Still, “The interventions created immediate benefits for participants – and they worked,” said Alexander C. Fanaroff, M.D., a study author, an expert in behavior change, and an interventional cardiologist and assistant professor of medicine in the Division of Cardiology at the University of Pennsylvania, Philadelphia. “Research shows it’s easier to think about today instead of the future, whether it’s exercising more to support long-term heart health or saving for a future goal, like college or retirement.”

Researchers said people wanting to change their behavior, especially around exercise, can focus on the same principles used in the study, which created immediate benefits or rewards for movement. For example, there are exercise apps that provide daily reminders and rewards for meeting personal health goals, people could enlist family and friends for support, and even create scenarios where they lose money by giving it away if they don’t meet their targets. Healthcare systems and organizations could also use tactics in the study to help patients increase physical activity levels. The research was supported by NHLBI grant R61/R33HL141440.

Reference: Fanaroff AC, Patel MS, Chokshi N, et al. Effects of gamification, financial incentives, or both to increase physical activity among patients at high risk of cardiovascular events: The BE ACTIVE randomized controlled trial. Circ. 2024; doi: 0.1161/CIRCULATIONAHA.124.069531.
   
                                                                                  ###     

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit https://www.nhlbi.nih.gov/.              

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov/.         

                                               NIH...Turning Discovery Into Health

---

JOURNAL

Circulation

DOI

10.1161/CIRCULATIONAHA.124.069531 

ARTICLE TITLE

Effects of gamification, financial incentives, or both to increase physical activity among patients at high risk of cardiovascular events: The BE ACTIVE randomized controlled trial

Successful “first in human” clinical trial of pioneering guidance for heart bypass surgery

University of Galway research at cutting edge of cardiovascular and coronary artery disease planning as trial shows non-invasive cardiac-CT, with AI-powered blood flow scanning, is safe and feasible

 NEWS RELEASE 7-APR-2024
UNIVERSITY OF GALWAY

 

IMAGE: 

PROFESSOR PATRICK W SERRUYS AND PROFESSOR YOSHI ONUMA IN THE CORRIB CORE LAB AT UNIVERSITY OF GALWAY.

view more 

CREDIT: UNIVERSITY OF GALWAY

A new approach to the guidance, planning and conduct of heart bypass surgery has been successfully tested on patients for the first time in a clinical trial coordinated by a research team at University of Galway.

The FAST TRACK CABG study, overseen by the University’s CORRIB Research Centre for Advanced Imaging and Core Lab, has seen heart surgeons plan and carry out coronary artery bypass grafting (CABG), based solely on non-invasive cardiac-CT scan images, with HeartFlow’s AI-powered blood flow analysis of the patient’s coronary arteries.

The research was published today in the European Heart Journal and is available at https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehae199

The key findings of this first-in-human study is the 99.1% feasibility, which means that heart bypass surgery without undergoing invasive diagnostic catheterisation is feasible and safe, driven by the good diagnostic accuracy of the cardiac CT scan and AI-powered blood flow analysis.

The trial was sponsored by University of Galway and funded by GE Healthcare (Chicago, USA) and HeartFlow, Inc. (Redwood City, California, USA).

In comparing the safety and effectiveness of heart bypass surgery, the trial had similar outcomes to recent surgical groups of patients who underwent conventional invasive angiogram investigations, which involves inserting a catheter through an artery in the wrist or groin to access diseased arteries and using dye to visualise blockages.

The findings of the FAST TRACK CABG trial suggest that the less invasive approach to heart bypass surgery offers comparable safety and efficacy to established methods. The research team noted that safety issues inherent to invasive investigation can be replaced by a non-invasive technique using CT scan imaging and AI-powered blood flow analysis.

Trial chairman Professor Patrick W Serruys, Established Professor of Interventional Medicine and Innovation at University of Galway, said: “The results of this trial have the potential to simplify the planning for patients undergoing heart bypass surgery. The trial and the central role played by the CORRIB Core Lab puts University of Galway on the frontline of cardiovascular diagnosis, planning and treatment of coronary artery disease.”

The study was carried out in leading cardiac care hospitals in Europe and the US and involved 114 patients who had severe blockages in multiple vessels, limiting blood flow to their heart.

The cardiac CT used in this study (Revolution CT, GE Healthcare) has a special resolution that makes the non-invasive images as good or even better than the images traditionally obtained by a direct injection of contrast dye in the artery of the heart through a catheter.

During the trial, the analysis of high resolution cardiovascular imagery and data was carried out by the CORRIB Core Lab team and shared by telemedicine with surgeons in trial hospitals.

The HeartFlowTM Analysis, which provides AI-powered blood flow analysis called Fractional Flow Reserve derived from CT (FFRCT), quantifies how poorly the narrowed vessel provides blood to the heart muscle, assisted the surgeon in clearly identifying which of the patient’s vessels should receive a bypass graft.

Professor Serruys added: “The potential for surgeons to address even the most intricate cases of coronary artery disease using only a non-invasive CT scan, and FFRCT represents a monumental shift in healthcare. Following the example of the surgeon, interventional cardiologists could similarly consider circumventing traditional invasive cineangiography and instead rely solely on CT scans for procedural planning. This approach not only alleviates the diagnostic burden in cath labs but also paves the way for transforming them into dedicated ‘interventional suites’- ultimately enhancing patient workflows.”

Dr Yoshi Onuma, Professor of Interventional Cardiology at University of Galway and the medical director of CORRIB Research Centre, said: “Exploring the potential for minimising diagnostic catheterisation procedures is important for several reasons- a catheterisation procedure is invasive and it is unpleasant for the patient. It is also costly for the health service. While there is a minimal risk associated with the procedure, it is not entirely risk free.

“CT scan analysis, FFRCT, and guidance from the team in Galway is a world first in bypass surgery. It may become a game-changer, altering the traditional relationship between GP, radiologist, cardiologist and cardio-thoracic surgeon for the benefit of the patient.”

Dr Saima Mushtaq, Director of Cardiovascular CT in Centro Cardiologico Monzino, Milan, Italy, said: “This is a historical trial that may change our approach for patients who are candidates for CABG revascularisation and with the FAST TRACK CABG trial we have been part of this revolution in which a CT scan is considered a tool to plan revascularisation skipping invasive coronary angiography.”

Dr John Puskas, Mount Sinai Morningside, New York and Professor of Cardiothoracic Surgery, Emory University Hospital Midtown, Atlanta, Georgia, said: “As the only North American surgeon, enrolling many patients in this trial, I have a unique perspective: I can conclusively state that there is no loss in diagnostic precision or accuracy nor any decrement in the quality of surgical planning or performance when the surgical team is guided solely by data from a latest-generation, non-invasive coronary CT scan. Once the surgeon is familiar with this new imaging modality, there are several ways in which it is actually a better guide than the historical invasive coronary angiogram.”

Professor Fidelma Dunne, Director of the Institute for Clinical Trials at University of Galway, said: “The outcomes of this inaugural human trial are highly promising, prompting further exploration of the advantages offered by this non-invasive methodology through an extensive randomised trial. At the Institute for Clinical Trials we are committed to conducting high-impact trials that have the potential to revolutionise patient care globally.”

The pioneering research of the CORRIB Core Lab at University of Galway into cardiovascular diagnosis and coronary artery disease will be further investigated in a large scale randomised trial. The research team is planning it will involve more than 2,500 patients from 80 hospitals across Europe.

Professor Professor Patrick W [VIDEO] | 

Professor Professor Patrick W Serruys in the CORRIB Core Lab at University of Galway explaining the results and significance FAST TRACK CABG trial

---

JOURNAL

European Heart Journal

DOI

10.1093/eurheartj/ehae199 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Coronary bypass surgery guided by computed tomography in a low-risk population

ARTICLE PUBLICATION DATE

7-Apr-2024

Stopping aspirin one month after coronary stenting procedures significantly reduces bleeding complications in heart attack patients

THE MOUNT SINAI HOSPITAL / MOUNT SINAI SCHOOL OF MEDICINE

 

IMAGE: 

THE PRIMARY EFFICACY ENDPOINT OF CLINICALLY-RELEVANT BLEEDING, DEFINED AS BARC TYPES 2, 3 OR 5 BLEEDING, WAS ASSESSED IN THE INTENTION-TO-TREAT POPULATION BETWEEN ONE-MONTH AND TWELVE-MONTHS POST-PCI IN PATIENTS WHO WERE EVENT-FREE AFTER ONE MONTH OF TICAGRELOR AND ASPIRIN. SWITCHING TO TICAGRELOR MONOTHERAPY AT ONE MONTH RESULTED IN A 55-PERCENT REDUCTION IN THE HAZARD OF CLINICALLY RELEVANT BLEEDING COMPARED WITH CONTINUING TICAGRELOR PLUS ASPIRIN OVER THE ENSUING 11 MONTHS.

view more 

CREDIT: MOUNT SINAI HEALTH SYSTEM

Withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined (also known as dual antiplatelet therapy or DAPT), which is the current standard of care.

These are the results from the ULTIMATE-DAPT study announced during a late-breaking trial presentation at the American College of Cardiology Scientific Sessions on Sunday, April 7, and published in The Lancet.

This is the first and only trial to test high-risk patients with recent or threatened heart attack (acute coronary artery syndromes, or ACS) taking ticagrelor with a placebo starting one month after PCI, and compare them with ACS patients taking ticagrelor with aspirin over the same period. The significant findings could change the current guidelines for standard of care worldwide.

“Our study has demonstrated that withdrawing aspirin in patients with recent ACS one month after PCI is beneficial by reducing major and minor bleeding through one year by more than 50 percent. Moreover, there was no increase in adverse ischemic events, meaning continuing aspirin was causing harm without providing any benefit,” says Gregg W. Stone, MD, the study co-chair of ULTIMATE-DAPT, who presented the trial results.

“It is my belief that it’s time to change the guidelines and standard clinical practice such that we no longer treat most ACS patients with dual antiplatelet therapy beyond one month after a successful PCI procedure. Treating these high-risk patients with a single potent platelet inhibitor such as ticagrelor will improve prognosis,” adds Dr. Stone, who is Director of Academic Affairs for the Mount Sinai Health System and Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai.

The study analyzed 3,400 patients with ACS at 58 centers in four countries between August 2019 and October 2022. All of the patients had undergone PCI, a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow. The patients were stable one month after PCI and were on ticagrelor and aspirin. Researchers randomized the patients after one month, withdrawing aspirin in 1,700 patients and putting them on ticagrelor and a placebo, while leaving the other 1,700 patients on ticagrelor and aspirin. All patients were evaluated between 1 and 12 months after the procedure.

During the study period, 35 patients in the ticagrelor-placebo group had a major or minor bleeding event, compared to 78 patients in the ticagrelor-aspirin group, meaning that the incidence of overall bleeding incidents was reduced by 55 percent by withdrawing aspirin. The study also analyzed major adverse cardiac and cerebrovascular events including death, heart attack, stroke, bypass graft surgery, or repeat PCI. These events occurred in 61 patients in the ticagrelor-placebo group compared to 63 patients in the ticagrelor-aspirin group, and were not statistically significant - further demonstrating that removing aspirin did no harm and improved outcomes.

“It was previously believed that discontinuing dual antiplatelet therapy within one year after PCI in patients with ACS would increase the risk of heart attack and other ischemic complications, but the present study shows that is not the case, with contemporary drug-eluting stents now used in all PCI procedures. Discontinuing aspirin in patients with a recent or threatened heart attack who are stable one month after PCI is safe and, by decreasing serious bleeding, improves outcomes,” Dr. Stone adds. “This study extends the results of prior work that showed similar results but without the quality of using a placebo, which eliminates bias from the study.”

This trial was funded by the Chinese Society of Cardiology, the National Natural Scientific Foundation of China, and Jiangsu Provincial & Nanjing Municipal Clinical Trial Project.

 

Mount Sinai is a World Leader in Cardiology and Heart Surgery

Mount Sinai Fuster Heart Hospital at The Mount Sinai Hospital ranks No. 1 in New York and No. 4 globally according to Newsweek’s “The World’s Best Specialized Hospitals.” It also ranks No. 1 in New York for cardiology, heart, and vascular surgery, according to U.S. News & World Report®.  

It is part of Mount Sinai Health System, which is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. We advance medicine and health through unrivaled education and translational research and discovery to deliver care that is the safest, highest-quality, most accessible and equitable, and the best value of any health system in the nation. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report's® “Best Hospitals” Honor Roll for 2023-2024.

For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

  

CAPTION

The primary safety endpoint of MACCE, the composite cardiac death, myocardial infarction, ischaemic stroke, definite stent thrombosis, or clinically-driven target vessel revascularization, was assessed in the intention-to-treat population between one-month and 12-months post-PCI in patients who were event-free after one month of ticagrelor and aspirin. During the next eleven months patients treated with ticagrelor monotherapy had similar rates of adverse ischaemic events as patients who were maintained on ticagrelor plus aspirin.

PCI denotes percutaneous coronary intervention; BARC denotes Bleeding Academic Research Consortium; MACCE, major adverse cardiovascular or cerebrovascular events; HR, hazard ratio; CI, confidence interval.

CREDIT

Mount Sinai Health System

JOURNAL

The Lancet

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Ticagrelor Alone Versus Standard DAPT Between One and Twelve Months After PCI in ACS: The randomised, placebo-controlled, double-blind ULTIMATE-DAPT trial

ARTICLE PUBLICATION DATE

7-Apr-2024

SOCK NOT SHOCK

Electronic sock detects unhealthy walking style

EUROPEAN SOCIETY OF CARDIOLOGY

Berlin, Germany – 7 April 2024:  An electronic sock that detects an unhealthy walking style linked with diabetes and poor circulation shows promise for preventing foot ulcers and amputation. The novel research is set to benefit the many patients with diabetes who have clogged arteries in the legs and is presented for the first time at EHRA 2024, a scientific congress of the European Society of Cardiology (ESC).1 

Study author Dr. Ki Hong Lee of Chonnam National University Hospital, Gwangju, Republic of Korea said: “Diabetes can affect the way people walk, also known as their gait. Patients with diabetes tend to put pressure on the metatarsal area of the foot, rather than the heel. This way of walking encourages ulcers, which can become infected and lead to amputation. Identifying walking issues early using an electronic sock would enable patients to learn a healthy walking style and prevent serious foot problems.” 

Around 1 in 10 people – 537 million in total – have diabetes worldwide,2 putting them at a two- to four-fold higher risk of coronary artery disease, stroke, heart failure, atrial fibrillation and peripheral artery disease compared to their healthy peers.3 Foot problems are common in diabetes. High blood sugar damages the nerves and blood vessels, with symptoms including numbness, tingling, pain, and loss of feeling. The symptoms can be difficult to detect in the early stages, meaning that cuts and ulcers may develop and become infected. The combination of an infection and poor blood flow makes healing difficult and can lead to gangrene and, ultimately, amputation. 

This study examined whether a sock fitted with a ballistocardiogram (BCG) sensor could distinguish between healthy people and patients with diabetes. A BCG detects body motion as the heart ejects blood, and could potentially be used to measure heart rate and pressure exerted on the feet when walking. 

The study enrolled 20 patients with diabetes and 20 controls without diabetes. All participants wore the BCG sock for 40 seconds while standing and 40 seconds while walking to measure heart rate and to assess pressure distribution on the foot. At the same time as wearing the sock, participants had an electrocardiogram (ECG) assessment of heart rate using a small patch attached to the wrist and a single electrode adhered to the chest. ECG is the gold standard tool in cardiology for measuring heart rate. 

The purpose of the heart rate measurement was to assess the accuracy of the BCG sock as a measurement tool relative to ECG, the gold standard method. For this analysis, ECG values in each study participant (patients and controls) were compared with BCG values in the same participant. The researchers found that the heart rate measurements by the BCG sock and ECG were almost same, with a correlation coefficient of 0.99 (95% confidence interval 0.99-1.00). 

The foot pressure distribution measurements were performed to discover whether the BCG sock could 1) detect differences between patients with diabetes and healthy controls, and 2) detect differences between patients with diabetes according to whether or not they had damage to the nerves or blood vessels. Nerve damage was classified using the Michigan Neuropathy Screening Instrument (MNSI), while blood vessel damage was classified using the ankle-brachial index (ABI). 

Regarding the BCG comparison between patients and healthy controls, this showed that patients with diabetes exerted higher pressure in the metatarsal area of the foot while walking compared to participants without diabetes. For the BCG comparison between patients with diabetes, the researchers found that compared to patients without blood vessel damage (ABI score of 0.9 or higher), those with blood vessel damage (ABI score less than 0.9) exerted significantly greater pressure on the metatarsal area of the foot during walking and less pressure on the heel. There was no significant difference in foot pressure distribution measurements between patients with or without nerve damage. 

Dr. Lee said: “The novel BCG sock produced accurate measurements of heart rate as indicated by the nearly identical values as ECG. The pressure measurements showed that the sock could identify patients with diabetes, and could also pinpoint patients with diabetes and poor circulation. Taken together, the results suggest that the electronic sock could be an easy, non-invasive way to find patients with diabetes who could benefit from gait training to prevent foot complications.” 

 

ENDS 

 

Authors: ESC Press Office  
Tel: +33 (0)489 872 075 

Email: press@escardio.org 

Follow us on X @ESCardioNews  

 

Notes to editor 

Funding: This study was supported by a CNUH-GIST research collaboration grant funded by the Chonnam National University Hospital Biomedical Research Institute. 

References and notes 

1The abstract ‘Wearable self-powered ballistic signal detectors with ferroelectric composites arrays for cardiovascular and diabetic complication’ will be presented during the session ‘Basic Science 1’ which takes place on 7 April 2024 at 17:30 CEST at Moderated ePosters 1. 

2International Diabetes Federation. IDF Diabetes Atlas: https://diabetesatlas.org/. 

3Marx N, Federici M, Schütt K et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023;44:4043–4140. 

 

About the European Heart Rhythm Association 

The European Heart Rhythm Association (EHRA) is a branch of the European Society of Cardiology (ESC). Its aim is to improve patients’ quality of life and reduce sudden cardiac death by limiting the impact of heart rhythm disturbances.  

 

About the EHRA Congress     #EHRA2024 

EHRA 2024 is the annual congress of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). 

 

About the European Society of Cardiology  

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives. 

 

Remote care approach improved therapy adherence and uptake in patients with type 2 diabetes

Mass General Brigham study found earlier and greater uptake of medication when a remote care team delivered simultaneous education and medication management compared to a period of education before medication management

BRIGHAM AND WOMEN'S HOSPITAL

KEY TAKEAWAYS

• Researchers at Mass General Brigham tested a remote patient education and navigation program with 200 patients who had type 2 diabetes and elevated cardiovascular/kidney risk.
• Patients who received education simultaneously with treatment were more likely to begin and adhere to treatment while a period of education prior to therapy initiation was inferior for prescription acceptance and therapy uptake.
• The study highlights the importance of “striking while the iron is hot” and the potential for remote, team-based care to bridge healthcare gaps and enhance patient outcomes.

A new study by investigators from Mass General Brigham  demonstrated that a remote team focused on identifying, educating and prescribing therapy can improve guideline-directed-medical-therapy (GDMT) adherence in patients with type 2 diabetes and high cardiovascular and/or kidney risk. The research team observed that patients who received education simultaneously with medication management demonstrated a higher rate of medication uptake and initiated treatment earlier compared to patients who received education over two months prior to medication management. Their results were presented at the 2024 American College of Cardiology’s Annual Scientific Session and simultaneously published in Circulation.

“Our results suggest that patients are more inclined to adhere to therapy when approached with education and treatment simultaneously and immediately,” said corresponding author Alexander J. Blood, MD, MSc, who presented the results. Blood serves as an attending physician in the Division of Cardiovascular Medicine as well as the Heart and Vascular Center at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “Providers should ‘strike while the iron is hot.’ If a patient is already interested in investing in their health and willing to meet with you, that’s the time to initiate treatment while providing educational resources.”

Type 2 diabetes, which increases an individual’s risk of cardiovascular and kidney events, affects millions of adults in the United States. Medications such as SGLT2 inhibitors and GLP-1 receptor agonists can improve cardiovascular and kidney outcomes in patients with type 2 diabetes, but data from clinical trials and society recommendations have not led to widespread adoption and utilization of these therapies.

To investigate the impact of patient education on prescription acceptance and therapy uptake, the research team conducted a parallel, randomized, open label clinical trial. The study was funded by the Novo Nordisk Foundation. They enrolled 200 adult patients with type 2 diabetes at Mass General Brigham, who were at elevated risk of cardiac and/or kidney complications. Patients were randomly assigned to one of two groups. The “education-first” group received a dedicated two-month period of education, consisting of curated patient-centric videos on disease management and medication, prior to treatment initiation via an online portal. The second “simultaneous” group had access to the educational videos but received patient education concurrently with the initiation of their treatment.

Both groups received treatment through a research and clinical care management platform designed and created by the Accelerator for Clinical Transformation at Brigham and Women’s Hospital and Mass General Brigham, which facilitated care coordination among patient navigators, pharmacists, nurse practitioners and physicians. These healthcare professionals guided patients through every step of their engagement with health care and streamlined communication. The platform is part of Mass General Brigham’s larger efforts to transform healthcare delivery by helping patients access services and monitor health from home, especially at a time when hospitals are regularly operating over capacity.

Patients were followed for six months from enrollment or one month after medication initiation, whichever duration was longer.

While patients in both groups experienced benefits such as weight loss and reductions in blood glucose levels by the end of the study, those who received simultaneous education demonstrated a higher retention rate. Specifically, 60 percent of patients in this group were confirmed to have taken their prescribed therapy, compared to 44 percent in the “education-first” group. Additionally, contrary to initial predictions, patients in the “education-first” group did not engage more with the educational platform than those in the simultaneous group.

While the findings suggest that a pre-treatment education period may not be the solution to medication adherence issues, they underscore the potential of remote, team-based care delivery. This approach holds promise in facilitating the implementation of new therapies, bridging care quality disparities, and enhancing healthcare outcomes across diverse populations. The authors describe how the flexibility inherent in remote treatment may extend access to care, particularly benefiting traditionally underserved populations or individuals with busy schedules. Moreover, the inclusion of a patient navigation team fosters ongoing patient-provider communication, providing the personalized support necessary for sustained patient engagement in their care.

"We strongly believe that remote care programs that leverage non-licensed navigators, clinical pharmacists, and team-based care, together with a care delivery platform, will improve operational efficiencies and communication and thereby address many of the persistent problems in health care," said Benjamin M. Scirica, MD, MPH, principal investigator of the DRIVE study and director of the Accelerator for Clinical Transformation. "On a broader scale, programs like this enhance access, elevate patient outcomes, reduce physician burden, and promote the appropriate utilization of guideline-recommended medications."

Authorship: Mass General Brigham authors of the study include Alexander J. Blood, Lee-Shing Chang, Shahzad Hassan, Jacqueline Chasse, Gretchen Stern, Daniel Gabovitch, David Zelle, Caitlin Colling, Samuel J. Aronson, Christian Figueroa, Emma Collins, Ryan Ruggiero, Jorge Plutzky, Thomas A. Gaziano, Christopher P. Cannon, Deborah J. Wexler, and Benjamin M. Scirica.

Additional authors include Emily Zacherle, Joshua Noone, and Carey Robar.

Disclosures: Zacherle, Noone, and Robar are employees of Novo Nordisk. Blood, Chang, Hassan, Chasse, Aronson, Cannon, and Scirica have received grants from Novo Nordisk. Blood and Plutzky have consulted for Nov Nordisk. Wexler serves on Data Monitoring Committees for Novo Nordisk. Additional disclosures can be found in the paper and presentation.

Funding: This project was funded by Novo Nordisk, Inc.

Paper cited: Blood, A et al. “The Diabetes Remote Intervention to improVe use of Evidence-based medications (DRIVE) Study:  A randomized evaluation of a team-based remote education and medication management program to reduce CV and kidney risk” Circulation DOI: 10.1161/CIRCULATIONAHA.124.069494

For More Information:

• Healthcare at Home
• Accelerator for Clinical Transformation
• Mass General Brigham Remote Healthcare Delivery Program Improves Blood Pressure and Cholesterol Levels
• Remote Blood Pressure Management Program Enhanced Care During Pandemic

###

---

JOURNAL

Circulation

DOI

10.1161/CIRCULATIONAHA.124.069494 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The Diabetes Remote Intervention to improVe use of Evidence-based medications (DRIVE) Study: A randomized evaluation of a team-based remote education and medication management program to reduce CV and kidney risk

ARTICLE PUBLICATION DATE

7-Apr-2024

COI STATEMENT

Zacherle, Noone, and Robar are employees of Novo Nordisk. Blood, Chang, Hassan, Chasse, Aronson, Cannon, and Scirica have received grants from Novo Nordisk. Blood and Plutzky have consulted for Nov Nordisk. Wexler serves on Data Monitoring Committees for Novo Nordisk. Additional disclosures can be found in the paper and presentation.

PLAGUE PANIC

Over 90 killed after fishing boat sinks off Mozambique coast

AFP |
Apr 08, 2024


"There are 91 people who lost their lives," said Jaime Neto, secretary of state for the northern province of Nampula.

More than 90 people died when an overcrowded makeshift ferry sank off the north coast of Mozambique, local authorities said on Sunday.

The boat was carrying about 130 people(Rep image )

The converted fishing boat, carrying about 130 people, ran into trouble as it tried to reach an island off Nampula province, officials said.

"Because the boat was overcrowded and unsuited to carry passengers it ended up sinking ... There are 91 people who lost their lives," said Nampula's secretary of state Jaime Neto.

Many children were among the victims, he added

Rescuers had found five survivors and were searching for more, but sea conditions were making the operation difficult.

Most passengers were trying to escape the mainland because of a panic caused by disinformation about cholera, Neto said.

The southern African country, one of the world's poorest, has recorded almost 15,000 cases of the waterborne disease and 32 deaths since October, according to government data.

Nampula is the worst affected region, accounting for a third of all cases.

An investigative team had was working to find out the causes of the boat disaster, the official said.

INDIA

Climate crisis impacts citizens’ right to life: Supreme Court

ByAbraham Thomas, New Delhi

Apr 08, 2024 

Climate change impacts the constitutional guarantee of right to life, the Supreme Court said in a recent judgment

Climate change impacts the constitutional guarantee of right to life, the Supreme Court said in a recent judgment, emphasising that India must prioritise clean energy initiatives such as solar power as citizens have a right to be free from the adverse effects of the climate emergency.

The judgment came on a petition by wildlife activist MK Ranjitsinh and others to protect the Great Indian Bustard (GIB), a critically endangered bird found only in Rajasthan and Gujarat. (HT Archive)

The judgment came on a petition by wildlife activist MK Ranjitsinh and others to protect the Great Indian Bustard (GIB), a critically endangered bird found only in Rajasthan and Gujarat. The court recalled an earlier order of April 2021 that required undergrounding of overhead transmission lines across an area of over 80,000 sq km in the two states after the Union government pointed out concerns on feasibility of implementing the order.

Unlock exclusive access to the story of India's general elections, only on the HT App. Download Now!

Read here: UN launches 'Weather Kids' campaign to encourage climate action

Moreover, since the major solar and wind energy producing installations of the country fall in the same area, the Centre claimed the court’s directions will harm India’s global commitments to reduce the carbon footprint by increasing dependence on renewable energy sources.

By the present order, passed on March 21, but uploaded recently, the bench formed an expert committee comprising independent experts, members of the National Board of Wildlife, representatives of power companies, and former and serving bureaucrats drawn from departments of environment and forests and ministry of new and renewable energy (MNRE) to suggest ways to balance two objectives – the conservation of the bird and India’s sustainable development goals. The committee’s first report is expected by July 31.

Accepting the concerns expressed by Centre, the bench headed by chief justice of India Dhananjaya Y Chandrachud said, “Without a clean environment which is stable and unimpacted by the vagaries of climate change, the right to life is not fully realised. The right to health (which is a part of the right to life under Article 21) is impacted due to factors such as air pollution, shifts in vector-borne diseases, rising temperatures, droughts, shortages in food supplies due to crop failure, storms, and flooding... From these, it emerges that there is a right to be free from the adverse effects of climate change.”

Discussing how tribals in Andaman and Nicobar Islands and such other indigenous communities that depend on nature, the court said, “The relationship that indigenous communities have with nature may be tied to their culture or religion. The destruction of their lands and forests or their displacement from their homes may result in a permanent loss of their unique culture. In these ways too, climate change may impact the constitutional guarantee of the right to equality.”

“If climate change and environmental degradation lead to acute food and water shortages in a particular area, poorer communities will suffer more than richer ones...The inability of underserved communities to adapt to climate change or cope with its effects violates the right to life as well as the right to equality,” said the bench, also comprising justices JB Pardiwala and Manoj Misra.

The Centre had told the court that India’s goal to achieve 500 GW of non-fossil-based electricity generation capacity by 2030 aligns with its efforts to be net zero by 2070. In 2023-24, out of the total generation capacity of 9,943 MW added, 8,269 was from non-fossil fuel sources. According to the Renewable Energy Statistics 2023 released by the International Renewable Energy Agency, India has the 4th largest installed capacity of renewables.

“Beyond mere adherence to international agreements, India’s pursuit of sustainable development reflects the complex interplay between environmental conservation, social equity, economic prosperity and climate change,” the court held.

“Clean energy aligns with the human right to a healthy environment,” the judgment said, pointing out specific concerns of “unequal energy access” for developing countries like India, where women spend an average of 1.4 hours a day collecting firewood and an average four hours cooking.

“Unequal energy access disproportionately affects women and girls due to their gender roles and responsibilities such as through time spent on domestic chores and unpaid care work... The importance of prioritizing clean energy initiatives to ensure environmental sustainability and uphold human rights obligations cannot be understated,” the court said.

Stating that solar energy stands out as a “pivotal solution” in the global transition towards cleaner energy sources, the judgment said, “It is imperative for states like India, to uphold their obligations under international law, including their responsibilities to mitigate greenhouse gas emissions, adapt to climate impacts, and protect the fundamental rights of all individuals to live in a healthy and sustainable environment.”

Transitioning to renewable energy is not just an environmental imperative but also a strategic investment in India’s future prosperity, resilience and sustainability, the court said. “The promotion of renewable energy sources plays a crucial role in promoting social equity by ensuring access to clean and affordable energy for all segments of society, especially in rural and underserved areas. This contributes to poverty alleviation, enhances quality of life, and fosters inclusive growth and development across the nation,” it added.

Of late, the court noted that globally courts are confronted with issues of climate change and human rights. Though India has a governmental policy and rules and regulations to combat the adverse effects of the climate crisis, the bench observed, “There is no single or umbrella legislation in India which relates to climate change and the attendant concerns...this does not mean that the people of India do not have a right against the adverse effects of climate change.”

It is imperative for India to not only find alternatives to coal-based fuels but also secure its energy demands in a sustainable manner as the court noted that India has pressing reasons to urgently shift to solar power. “India is likely to account for 25% of global energy demand growth over the next two decades; rampant air pollution emphasizes the need for cleaner energy sources; and declining groundwater levels and decreasing annual rainfall underscore the importance of diversifying energy sources,” it said.

The vast expanse of arid desert terrain and an abundance of sunlight in Gujarat and Rajasthan serves as prime areas for solar power generation. “By harnessing this natural advantage, India can significantly reduce its reliance on fossil fuels and transition towards cleaner energy sources,” the judgment said.

While asking the committee to determine the scope, feasibility and extent of overhead and underground electric lines in the area identified as priority GIB areas and propose steps for long-term conservation and protection of the GIB, the court noted the dilemma of protecting against climate change and preserving the critically endangered bird.

Read here: The link between climate crisis and your clock

“It is not a binary choice between conservation and development but rather a dynamic interplay between protecting a critically endangered species and addressing the pressing global challenge of climate change... If this Court were to direct that the power transmission lines be undergrounded in the entire area delineated above, many other parts of the environment would be adversely impacted,” it said.

For the long-term survival of the bird, the Court’s April 2021 order also required bird diverters to be installed along power lines. The court asked the committee to assess the efficacy of bird diverters and lay down specifications for it besides identifying and adding suitable areas for extending protection to the endangered bird.

A Wildlife Institute of India report, which formed the basis for passing the April 2021 direction, identified 13,663 sq km as “priority area”, 80,680 sq km as “potential areas”; and 6,654 sq km as “additional important areas” for the GIB.

The GIB is listed as critically endangered by the International Union for Conservation of Nature. They are protected under the Wildlife (Protection) Act, 1972. The GIB population in India was said to be 150 at the time when the April 2021 direction was passed. Since then, efforts are on to increase their population through captive breeding.