Focus on Prevention Raises Question: What Happens When People Won't Help Themselves?

For 2 days, the American Heart Association has done its best at the annual Scientific Sessions to highlight findings about prevention: results that, in the words of presenter C. Noel Bairey Merz, MD, reinforce “what your grandmother always told you,” about eating fruits and vegetables, exercising, and getting outside.

There’s just one problem. Several of the studies have reported “negative results,” which means that researchers’ hopes that an intervention would produce positive health effects simply didn’t pan out.

A study from California that used telemonitoring to keep track of heart failure patients after they were hospitalized didn’t find any overall benefit (although there were some signs that the more adherent patients had fewer readmissions).

A clinical trial that used smartphone technology to coach patients to adopt healthier behaviors in a sequence, rather than all at once, had success getting them to eat more fruits and vegetables, watch less television, and consume less saturated fat. But getting people to exercise? After 6 months, the average difference was 15 minutes a day (which is a major mprovement over the research team’s last attempt).

And findings on the effectiveness of the drug varenicline in helping long-term smokers quit started with this omimous statement, “Less than a third of smokers hospitalized with a heart attack or chest pain abstain from smoking after leaving the hospital.”

At AHA, and across medicine, clinicians are grappling with the fact that the most cost-effective solutions to better health won’t come from another pill or surgical technique. They have to come from patients taking better care of themselves. The question is, how?

“Adherence” is a 2-part problem: first, people need to follow better diet and exercise regimens; second, once doctors prescribe medicine, patients have to take it. The movement toward population health is aimed at requiring physicians and health plans to come up with strategies to come up with ways to get patients to do what they’re told.

Some clues may come in studying the patients that do choose to stick with interventions. Michael K. Ong, MD, PhD, associate professor at UCLA who was the lead author of the telemonitoring study, hinted as much when asked about this after he presented his findings at a press conference.

And Valentin Fuster, MD, professor of cardiology at the Icahn School of Medicine at Mount Sinai presented a multidimensional study that involved extensive training of peer leaders to lead group-based lifestyle interventions to address several factors, including smoking, diet, and exercise.

While there were reductions in weight and blood pressure, Fuster said once the 12% who quit the intervention were netted out, the results were much more favorable. And of the many variables measured, the patients were most successful at curbing tobacco use—which may be the most important step they could take in improving their health. The peer leadership factor may appears to be key, and follow-up in a year’s time is planned.

For its part, AHA is putting the organization’s weight behind the prevention message. It has announced that it will no longer schedule the Scientific Sessions in cities that do not have indoor smoke-free laws.