Enhanced motivational interviewing no more effective than usual care for CVD prevention
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Strategies with enhanced motivational interviewing did not improve physical activity or weight loss in patients at high CVD risk compared with standard community-based programs, nor were they cost-effective, according to results from the MOVE IT trial.
Neither group interventions nor individual interventions in which health trainers delivered 10 sessions over 12 months of techniques including motivational interviewing drawn from cognitive behavior therapy were more effective than standard community-based weight loss, smoking cessation or exercise programs, according to the researchers.
Ineffective interventions
According to research published in Heart, for patients aged 40 to 74 years with a 10-year QRISK2 score of at least 20%, group and individual interventions were no more effective than usual care in:
- increasing physical activity (mean difference for group intervention vs. usual care = 70.05 steps; 95% CI, 288 to 147.9; mean difference for individual intervention vs. usual care = 7.24 steps; 95% CI, 224.01 to 238.5);
- reducing weight (mean difference for group intervention vs. usual care = 0.03 kg; 95% CI, 0.49 to 0.44; vs. mean difference for individual intervention vs. usual care = 0.42 kg; 95% CI, 0.93 to 0.09); or
- secondary outcomes of lowering LDL levels and QRISK2 score at 12 to 24 months.
“We conclude that enhanced motivational interviewing have little impact for reducing CVD risk in people at high CVD risk when applied to the general population,” Khalida Ismail, BA, BM BCh, MRCP, MRCPsych, MSc, PhD, professor of psychiatry and medicine, King’s College London, and colleagues wrote. “This raises the question as to whether the administration of low-intensity psychological techniques in lifestyle-related interventions are of any clinical benefit.”
Value not demonstrated
In other findings, the researchers found the group intervention was more expensive and less effective than the usual care, whereas the individual intervention was more expensive and more effective than the usual care. They calculated that the incremental cost-effectiveness ratio (ICER) was 55,313 British pounds per quality-adjusted life-years (354 pounds divided by 0.0064 QALYs). The ICER of the individual arm compared with the group arm was 8,287 pounds per QALY (179 pounds divided by 0.0216 QALYs), according to the study.
According to the researchers, at a value of 30,000 pounds, the individual intervention had a 38.1% chance of being the most cost-effective option, the group intervention had a 3.2% chance and the usual care had a 58.7% chance.
“One explanation for the negative finding is that our sample was skewed to nonmodifiable risk factors in the QRISK2 algorithm (age, gender and ethnicity), and on average not obese with a lower than expected CVD risk score,” the researchers wrote. “Furthermore, participants had average and possibly optimum baseline step in line with healthy older adults. It may have been more appropriate to recruit by raised BMI, BP and LDL cholesterol, which are modifiable risk factors, or selected a higher QRISK2 score.”
The three-arm randomized controlled trial included 1,742 patients (mean age, 70 years; 86% men; 89% white; 15% current smokers) with a QRISK2 score of at least 20%.
“[This] intervention might have been more successful in those with modifiable CVD risk factors rather than the QRISK2 score alone and if we had much shorter waiting lists,” the researchers wrote. “The potential of an enhanced motivational interviewing approach to a younger population, those living in deprived areas and of nonwhite ethnicity remains unknown. We used the same strategies for recruitment regardless of socioeconomic, ethnicity and inner-city status and future studies could instead oversample in these subgroups to recruit those at higher CVD risk.” – by Scott Buzby
Disclosures: Ismail reports she received speaking honoraria from Eli Lilly, Janssen, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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