Self-Management Addressing Heart Disease Risk Trial (SMAHRT)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00499096
First received: July 9, 2007
Last updated: January 30, 2013
Last verified: January 2013

July 9, 2007
January 30, 2013
May 2008
May 2012   (final data collection date for primary outcome measure)
Blood pressure changes, cholesterol, health-related quality of life [ Time Frame: We anticipate changes will occur within 12 months of the initiation of the intervention. ] [ Designated as safety issue: No ]
Blood pressure changes, cholesterol, health-related quality of life
Complete list of historical versions of study NCT00499096 on ClinicalTrials.gov Archive Site
Utilization, symptoms [ Time Frame: We anticipate changes will occur within 12 months of the initiation of the intervention. ] [ Designated as safety issue: No ]
Utilization, symptoms
Not Provided
Not Provided
 
Self-Management Addressing Heart Disease Risk Trial
Cardiovascular Risk Factors in Veterans With Bipolar Disorder

The purpose of this research study is to learn whether or not people with bipolar disorder can reduce their risk of heart disease and related conditions by having a Care Manager provide self management and care management.

Background: Bipolar disorder is associated with significant personal and societal costs, and represents a substantial burden to the VA. Medical conditions, notably cardiovascular disease (CVD), are substantial contributors to increased morbidity and mortality in patients with bipolar disorder, in part because of behavioral and treatment factors. Despite the existence of effective medications for managing CVD-related risk factors (e.g., hypertension, hyperlipidemia, diabetes, obesity), outcomes for these conditions remain suboptimal among patients with bipolar disorder.

Objectives: The immediate objective of this study is to determine whether a manual-based Chronic Care Model (CCM) intervention compared to usual VA care improves control of intermediate physiological measures that represent risk factors of CVD for veterans with bipolar disorder. We hypothesize that, within 12 months of the intervention initiation, patients receiving the CCM intervention will be more likely to demonstrate improved control of CVD-related risk factors (blood pressure, fasting cholesterol) and report improved physical health-related quality of life.

Methods: This is a prospective, randomized, controlled, single-blind, single-site behavioral intervention trial of adult patients with a diagnosis of bipolar disorder receiving care in the VA Ann Arbor Healthcare System. Up to 300 subjects will be enrolled, of which 150 will be randomized to receive the intervention and 150 will receive usual VA care. All subjects will complete a baseline clinical assessment and then subsequent follow-up assessments at 3, 6, 12, and 24 months. The intervention's three core components will be implemented by a nurse Care Manager and include: 1) self-management behavioral sessions for patients addressing the reduction of CVD risk factors through symptom control and behavior change based on Social Cognitive Theory, 2) care management to promote patient behavior change and coordinate care, and 3) implementation of practice guidelines for providers on management of CVD risk factors in patients with bipolar disorder. Medical and psychiatric care, including medications, will continue to be provided by the patient's usual providers. Usual VA care will be enhanced and consist of guideline implementation and general patient education (attention control), but will not include self-management sessions or Care Manager contacts. Primary clinical outcomes include changes in cholesterol, and health-related quality of life (SF-12 physical health summary score). Linear regression models will be used to determine the effect of the intervention on each outcome. Mediators of treatment effect including symptoms and health behaviors will also be assessed.

Interventional
Phase 3
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Health Services Research
  • Bipolar Disorder
  • Cardiovascular Disease
Behavioral: Chronic care model involving self-management educational sessions, care management for up to 1 year, and guideline dissemination
The behavioral intervention is based on the Chronic Care Model (CCM) where patients receive information on managing bipolar symptoms and health habits in a group self-management session (up to 6 weekly sessions). The Care Manager then follows up with patients via phone contacts for 12 months following the intervention. The providers receive information on guidelines for care.
  • Arm 1
    An intervention group of patients with bipolar disorder and 1 or more risk factor for cardiovascular disease; group will receive self-management group sessions, followed by phone contacts by the Care Manager.
    Intervention: Behavioral: Chronic care model involving self-management educational sessions, care management for up to 1 year, and guideline dissemination
  • No Intervention: Arm 2
    A group of patients with bipolar disorder and one or more risk factors for cardiovascular disease will be randomized to receive enhanced usual care. This group will receive usual care, plus mailings on wellness topics (attention control), and their providers will receive information on guideline concordant care.
Kilbourne AM, Goodrich DE, Lai Z, Post EP, Schumacher K, Nord KM, Bramlet M, Chermack S, Bialy D, Bauer MS. Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT). J Clin Psychiatry. 2013 Jul;74(7):e655-62. doi: 10.4088/JCP.12m08082.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
118
November 2012
May 2012   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Diagnosis of bipolar disorder (I, II, NOS, or schizoaffective-bipolar subtype)
  • Have a diagnosis or be at risk for ASCVD (arteriosclerotic cardiovascular disease).

We define this as a patient having a current diagnosis of or receiving treatment for at least one of the following medical conditions:

  • hyperlipidemia or dyslipidemia (documented diagnosis or low-density lipoprotein >=160, or receiving statin or other treatment)
  • hypertension (documented diagnosis or blood pressure of >=140/90 on 2 occasions)
  • diabetes mellitus (documented diagnosis or HbA1C >=7%, or receiving treatment)
  • obesity (documented diagnosis or BMI >30), based on medical record review of current problems
  • current ASCVD diagnosis

Exclusion Criteria:

  • Have unresolved substance intoxication or withdrawal, such as appearing to be intoxicated (e.g., incoherent, slurred speech), or experiencing withdrawal symptoms from substance abuse at the time of enrollment.
  • Are already enrolled in a mental health program with a mobile outreach component in which clinical caregivers deliver services to the patient in the community (e.g., assertive community treatment or intensive case management). These patients may be receiving similar services to those offered in the intervention.
  • Are unwilling or unable to provide informed consent or comply with study requirements at the time of enrollment (e.g., unable to complete forms or attend scheduled sessions due to serious illness or substantial functional limitations).
Both
18 Years and older
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00499096
MBHA-018-06F
No
Department of Veterans Affairs
Department of Veterans Affairs
Not Provided
Principal Investigator: Amy M. Kilbourne, PhD MPH VA Ann Arbor Healthcare System
Department of Veterans Affairs
January 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP