Publications

Although a Dietary Approaches to Stop Hypertension (DASH) eating plan has been shown to lower blood pressure (BP) in Black adults, this intervention has not been tested in individuals who were being actively treated for hypertension. In this study, we conducted a randomized clinical trial (GoFreshRx) to test whether local groceries ordered with the assistance of a dietitian to align with the DASH diet might lower BP among Black adult residents of Boston communities with few grocery stores who were being actively treated for hypertension. Individuals whose systolic blood pressure (SBP) was 120 mmHg to <150 mmHg despite active hypertension treatment were randomized either to 12 weeks of weekly home-delivered DASH groceries with dietitian counseling or to receiving three US$500 stipends every 4 weeks. The primary outcome was research clinic-measured SBP measured at 3 months. Secondary outcomes were diastolic blood pressure (DBP) and low-density lipoprotein cholesterol (LDL-c) levels. Maintenance of health effects was assessed at 3 months after the intervention. Of 176 participants (mean age 60.1 (s.d., 11.5) years; 80.7% female), 173 were available for SBP measurement at 3 months. Mean (s.d.) baseline SBP/DBP was 130.5 (7.0)/77.8 (8.9) mmHg. At 3 months, SBP changed by -7.0 mmHg in the DASH groceries group and by -2.0 mmHg in the self-directed group (intergroup difference: -5.0 mmHg; 95% confidence interval: -8.0 to -1.9; P = 0.002). Moreover, compared to the self-directed group, 3 months of DASH groceries changed DBP by -1.8 mmHg (-3.6 to -0.1) and LDL-c by -7.0 mg dl-1 (-13.6 to -0.5). In prespecified analyses, the beneficial effects of DASH grocery delivery on SBP and DBP were partially maintained 3 months after the intervention had concluded. Nutrient-targeted grocery ordering appears to be a useful strategy to improve longer-term cardiometabolic health. ClinicalTrials.gov registration: NCT05393232 .

BACKGROUND: Although socioeconomic status (SES) is a known determinant of cardiovascular disease, the independent risks of incident heart failure (HF) and consequent mortality portended by individual and neighborhood measures of SES remain less established.

OBJECTIVES: This study sought to evaluate the prospective associations of SES with HF in adults without HF and SES with all-cause mortality in those with HF.

METHODS: The authors identified adults from the National Institutes of Health-run All of Us Research Program (2018-present) who consented to share their electronic health records. Among 280,431 participants free of HF and 10,550 participants with prevalent HF, Cox proportional hazards models assessed associations of income, education, and Area Deprivation Index (ADI) with risks of incident HF and mortality.

RESULTS: Over 41 ± 23 months, 6,783 of 280,431 participants developed HF. Compared with household income ≥$200,000, risk was higher for $100,000 to <$200,000 (HR: 1.29; 95% CI: 1.12-1.48), $50,000 to <$100,000 (HR: 1.82; 95% CI: 1.60-2.09), $25,000 to <$50,000 (HR: 2.24; 95% CI: 1.95-2.57), and <$25,000 (HR: 3.02; 95% CI: 2.63-3.47). Relative to college graduates, risk was higher for those with some college (HR: 1.37; 95% CI: 1.28-1.46), General Educational Development (HR: 1.46; 95% CI: 1.36-1.58), and less than high school (HR: 1.40; 95% CI: 1.26-1.55). Compared with the least deprived tertile of ADI, risk was higher in the middle tertile (HR: 1.21; 95% CI: 1.14-1.29) and the most deprived tertile (HR: 1.18; 95% CI: 1.11-1.26). Non-White participants and residents of the most deprived ADI tertiles experienced less benefit from higher education. Among those with prevalent HF, each $10,000 increase in income was associated with 3% lower all-cause mortality.

CONCLUSIONS: Lower income, education, and high neighborhood deprivation independently associate with incident HF, whereas only income was associated with mortality. Higher education was less protective in non-White participants and individuals residing in deprived neighborhoods. Addressing these disparities is essential to reducing HF burden and consequent mortality.

OBJECTIVE: Postdischarge transitions from the hospital to home in older (≥65 years) colorectal surgery patients have a high risk of medication errors, complications, and worsening of existing conditions. Up to 14% are readmitted within 30 days, costing  $180 million annually. The anticipated 50% increase in colorectal cancer surgeries in older adults by 2040 necessitates an improvement in care transitions and outcomes.

METHODS: We conducted semi-structured qualitative interviews with 10 surgeons from 8 US health systems to inform the design of a multicomponent care transition model. We selected participants through stratified purposive sampling based on experience with older surgical patients and/or leadership roles. Consolidated Criteria for Reporting Qualitative Studies guidelines were followed, and a detailed line-by-line editing and organizing style was used to analyze transcripts.

RESULTS: The interviews identified challenges in care transitions and potential solutions, and 4 themes emerged: (1) Discharge planning should start before surgery and incorporate preoperative geriatrics evaluation and planning; (2) Coordinated communication and collaboration among multidisciplinary care teams are necessary but often lacking; (3) Educating older surgical patients and their care partners and involving them in care decisions is needed for successful management of care responsibilities after discharge; and (4) The complex and fragmented healthcare system creates care challenges postdischarge.

CONCLUSIONS: Discharge planning that begins preoperatively, integrates geriatrics domains, ensures timely and coordinated interdisciplinary communication postdischarge, and emphasizes patient and family education is essential to improve care transitions in older colorectal surgery patients. A multilevel care transition model incorporating these elements may enhance outcomes and reduce readmissions.

BACKGROUND: Black adults in the United States face significant cardiovascular health disparities, which are likely exacerbated by the underrepresentation of Black adults in cardiovascular clinical trials. The Black adult US population has experienced unique historical events, discriminatory practices, and practical obstacles that might contribute to this underrepresentation in clinical trials. An improved understanding of motivations that encourage or discourage participation in cardiovascular clinical trials can lead to more effective clinical trial recruitment and help mitigate these cardiovascular health disparities.

OBJECTIVE: This study aimed to determine, using an online survey, which motivational themes in clinical trial recruitment advertisements were most effective in encouraging Black adults to participate in a hypertension-focused trial. We also examined how trust in health care and various demographic factors influenced their decision to participate.

METHODS: We conducted an online survey with 829 self-identified Black adults in the United States, using a between-subject design to test 4 literature-derived motivational themes in clinical trial recruitment advertisements: (1) contribution to science, (2) helping the community, (3) lowering blood pressure, and (4) access to perks (US $500 worth of groceries or an equivalent cash amount). We assessed advertisement appeal, willingness to participate, and willingness to recommend clinical trial participation to others using cumulative link mixed models.

RESULTS: Demographic factors played a more significant role than motivational themes in predicting advertisement effectiveness. Adults aged 40-59 years and individuals diagnosed with high blood pressure were more likely to find the advertisements appealing and express willingness to participate. Urban residents engaged more with the advertisements compared to those in suburban or rural areas. Participants with liberal (odds ratio [OR] 1.37, 95% CI 1.01-1.85; P=.04) and conservative (OR 1.62, 95% CI 1.09-2.40; P=.02) political views were more willing to participate in the clinical trial compared to those with moderate views. However, the "lowering my blood pressure" theme was less effective among individuals who distrusted health care institutions (OR 0.40, 95% CI 0.16-0.97; P=.04) and also reduced willingness to recommend the trial (OR 0.36, 95% CI 0.15-0.85; P=.02). In addition, higher trust levels were unexpectedly associated with lower willingness to participate when exposed to this theme (OR 0.41, 95% CI 0.17-0.98; P=.04).

CONCLUSIONS: Demographic targeting (age, health status, and geographic location) is more critical than generic motivational messaging in recruiting Black adults to clinical trials. Successful digital health recruitment requires targeting specific demographic segments with tailored messages, as effectiveness varies significantly across sociodemographic factors. The online survey methodology offers researchers a rapid, scalable tool for pretesting recruitment strategies, though it should complement rather than replace community engagement. These insights can help reduce cardiovascular health disparities by improving clinical trial representativeness.