Patient-centred follow-up consultations improve goal attainment in CVD risk patients

BACKGROUND: Cardiovascular diseases (CVD) are the leading cause of death worldwide, with lifestyle-related risk factors such as unhealthy diet, physical inactivity or smoking playing a crucial role. Patient-centred care, which actively engages patients in setting and achieving their health goals, has become increasingly important in treatment and prevention. The Goal Attainment Scaling (GAS) provides a structured method to assess individual goal attainment and satisfaction. This study examines the frequency, attainment, and satisfaction with health goals among patients with at least one lifestyle-related risk factor for CVD within the DECADE intervention. The primary objective of the DECADE intervention was to improve patients' self-management to reduce their cardiovascular disease risk. One part of the study involved assessing health goals. METHODS: The cluster-randomised controlled DECADE study consisted of four study arms. The intervention groups (IG) received evidence-based health materials (IG1) and/or patient-centred follow-up consultations (IG2 and IG3). The control group (CG) received at the beginning (t0) of the intervention and after 12 months (t2) a CVD risk assessment like the intervention groups. The analysis sample comprises n = 712. Health goals, their attainment (6-point Likert scale, 0 = not achieved at all/worse than before to 5 = more achieved than before), and satisfaction with goal attainment (5-point Likert Scale, 1 = very satisfied - 5 = very dissatisfied) took place after 6 months (t1) and t2. GAS values were analysed using means, medians and group differences using Kruskal-Wallis tests. RESULTS: The participants reported a median of six health goals at t1 and t2. The most frequently set goals were healthy diet, regular physical activity, and weight reduction. While most patients reported achieving healthy diet and physical activity goals, weight reduction was less frequently attained. Despite largely attaining their goals (median=2.74 [0.33-5.00]; median=2.71 [0.00-5.00]), patients reported that they were only partially satisfied with their results (median=2.80 [1.00-5.00]; median=2.75 [1.00-5.00]). Patients receiving follow-up consultations (IG2 and IG3) showed significantly higher GAS scores at t2 than those in groups without consultations (CG and IG1) (median=2.80; median=2.86 vs. median=2.50; median=2.58, p = 0.004). No gender- or income-specific differences were found, but regional differences emerged: Patients in Dresden had significantly higher GAS scores and were more satisfied compared to those in Hamburg and Freiburg (p < 0.001). CONCLUSION: The findings highlight the potential of patient-centred consultations and the promotion of individual health goals in the treatment and in the prevention of CVD. Follow-up consultations positively influence goal attainment, emphasizing the need for structured patient-centred communication. Interestingly achieving health goals did not correspond to satisfaction of the patients. TRIAL REGISTRATION: The DECADE-study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00025401; Trial registration date: 2021/06/21) and in the International Clinical Trials Registry Platform (ICTRP): https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00025401 .