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Intensive Behavioral Counseling in Cardiovascular Care

Year: 2023

Type: editorial

Abstract: A s stated by the American College of Cardiol- ogy, diversity and inclusion are issues that are central to quality patient care, and innovation and advancements are essential to improve health equity and ensure equitable cardiovascular care and cardiovascular health for all. 1 Yet, in the United States, health and well-being are limited by profound social, environmental, and systemic inequities.Historically excluded people, including men and women of under-represented races and ethnicities are more likely to experience extreme disadvantages, including structural racism, food deserts and insecurity, unsafe neighborhoods, and difficulties accessing and maintaining routine health care.These barriers are routinely encountered throughout the lifespan, contribute to a greater confluence of cardiovascular risk factors-tobacco use, obesity, physical inactivity, poor sleep quantity and quality, high blood pressure, high blood sugar, and high cholesterol-leading to greater cardiovascular morbidity and mortality.1 In a global case-control study from over 50 countries, behavioral and lifestyle factors together accounted for at least 90% of population attributable risk for a first acute myocardial infarction among men and women. 2 Thus, attenuating cardiovascular risk at large, and particularly among the groups that are most vulnerable to cardiovascular health inequities, requires addressing these factors.Intensive behavioral counseling (IBC) is an empirically validated, evidence-based approach for primary and secondary cardiovascular disease prevention that applies the science of motivation and behavior change to support cardiovascular health through group or individual interventions over the course of 6 to 18 months.Given the high prevalence of cardiovascular risk factors in the United States, most adults would likely benefit from IBC.Furthermore, as demonstrated in the primary care context, the inclusion of IBC as part of an integrated treatment approach to care, can improve the equitable provision of care to members of historically excluded and minoritized groups.Thus, to promote health equity, IBC for cardiovascular risk reduction must be available and accessible to all, adaptable to various health care settings, and sustainable.IBC interventions, as defined by the United States Preventive Services Task Force (USPSTF), are preventive services designed to promote health behaviors.More specifically, IBC interventions are intended to change and improve health behaviors regarding diet, physical activity, and other cardiovascular health metrics.Importantly, IBC is also safe and effective for members of historically excluded and minoritized groups.A recent systematic review of U.S.-based clinical trials examining IBC to improve

Source: JACC Advances

DOI: 10.1016/j.jacadv.2023.100678