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O'Malley PG, Feuerstein IM, Taylor AJ. Impact of Electron Beam Tomography, With or Without Case Management, on Motivation, Behavioral Change, and Cardiovascular Risk Profile: A Randomized Controlled Trial. JAMA. 2003;289(17):2215–2223. doi:10.1001/jama.289.17.2215
Author Affiliations: Departments of Medicine (Drs O'Malley and Taylor) and Radiology (Dr Feuerstein), Walter Reed Army Medical Center, Washington, DC; and the Uniformed Services University of the Health Sciences, Bethesda, Md (Drs O'Malley, Feuerstein, and Taylor).
Context Although the use of electron beam tomography (EBT) as a motivational
tool to change behavior is practiced, its efficacy has not been studied.
Objective To assess the effects of incorporating EBT as a motivational factor
into a cardiovascular screening program in the context of either intensive
case management (ICM) or usual care by assessing its impact over 1 year on
a composite measure of projected risk.
Design Randomized controlled trial with a 2 × 2 factorial design and
1 year of follow-up.
Setting and Participants A consecutive sample of 450 asymptomatic active-duty US Army personnel
aged 39 to 45 years stationed within the Washington, DC, area and scheduled
to undergo a periodic Army-mandated physical examination were enrolled between
January 1999 and March 2001 (mean age, 42 years; 79% male; 66 [15%] had coronary
calcification; mean [SD] predicted 10-year coronary risk, 5.85% [3.85%]).
Interventions Patients were randomly assigned to 1 of 4 intervention arms: EBT results
provided in the setting of either ICM (n = 111) or usual care (n = 119) or
EBT results withheld in the setting of either ICM (n = 124) or usual care
(n = 96).
Main Outcome Measure The primary outcome measure was change in a composite measure of risk,
the 10-year Framingham Risk Score (FRS).
Results Comparing the groups who received EBT results with those who did not,
the mean absolute risk change in 10-year FRS was +0.30 vs +0.36 (P = .81). Comparing the groups who received ICM with those who received
usual care, the mean absolute risk change in 10-year FRS was −0.06 vs
+0.74 (P = .003). Improvement or stabilization of
cardiovascular risk was noted in 157 patients (40.2%). In multivariable analyses
predicting change in FRS, after controlling for knowledge of coronary calcification,
motivation for change, and multiple psychological variables, only the number
of risk factors (odds ratio, 1.42; 95% confidence interval, 1.16-1.75 for
each additional risk factor) and receipt of ICM (odds ratio, 1.62; 95% confidence
interval, 1.04-2.52) were associated with improved or stabilized projected
Conclusions Using coronary calcification screening to motivate patients to make
evidence-based changes in risk factors was not associated with improvement
in modifiable cardiovascular risk at 1 year. Case management was superior
to usual care in the management of risk factors.
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