A feasibility study of the CRISP intervention; a cardiovascular risk reduction intervention in patients with an abdominal aortic aneurysm

Tom M Withers; Colin J Greaves; Matt J Bown; Faye Ashton; Aimee J Scott; Vanessa E Hollings; Ann M Elsworth; Athanasios Saratzis

doi:10.3310/nihropenres.13596.2

A feasibility study of the CRISP intervention; a cardiovascular risk reduction intervention in patients with an abdominal aortic aneurysm

NIHR Open Res. 2024 Sep 3:4:34. doi: 10.3310/nihropenres.13596.2. eCollection 2024.

Authors

Tom M Withers¹, Colin J Greaves¹, Matt J Bown², Faye Ashton², Aimee J Scott¹, Vanessa E Hollings², Ann M Elsworth², Athanasios Saratzis²

Affiliations

¹ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, England, UK.
² Department of Cardiovascular Sciences & NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, England, UK.

Abstract

Background: Abdominal aortic aneurysm (AAA) screening/surveillance is implemented widely. Those in AAA-surveillance are at high-risk of cardiovascular-events. We developed an intervention, called CRISP, using intervention-mapping, to reduce cardiovascular-risk in AAA-surveillance. This study tested the CRISP intervention in routine clinical-care.

Methods: The CRISP intervention, consisting of a nurse-led cardiovascular risk assessment and subsequent lifestyle change support using a self-care workbook and low-intensity nurse input was delivered in two screening/surveillance programmes. Those consenting to take part were followed-up with cardiovascular-assessments. Fidelity of intervention-delivery was assessed quantitatively/qualitatively.

Results: 40 men (mean age 75 ± 7 years) took part over four months and followed-up for a minimum six months. A sub-group of 25 patients and nine Health Care Professionals (HCPs) were interviewed. The median number of risk-factors that patients chose to focus on was two (range 0 to 4), with physical activity (n=17) being the most popular. Participants who had a 'red light' risk factor for stress, low mood, smoking or alcohol intake were offered a referral to appropriate services. Two were offered referral to mental-health services and took it up, three declined referrals to smoking or alcohol support services. The fidelity of intervention-delivery (a score intervention components delivered to each patient based on a score from 0 to 5, with 5 being highest delivery fidelity) was generally low. The highest mean score (on a 0-5 scale) for the nurse assessment was 1.5 for engaging the participant, lowest 0.5 for exploring the importance for selected lifestyle behaviours. In qualitative interviews, the intervention was liked by patients/HCPs. Based on qualitative interviews and observations, the low fidelity of intervention-delivery was due to intervention-training not being detailed.

Conclusions: CRISP can be delivered in AAA-surveillance, but fidelity of delivery is low. The intervention and its training need to be refined/tested before wider implementation.

Registration: ISRCTN9399399518/11/20).

Keywords: Abdominal aortic aneurysm; Intervention development; Intervention mapping.

Grants and funding

This project is funded by the National Institute for Health and Care Research (NIHR) under its ‘NIHR Fellowships Programme’ (Grant Reference Number NIHR300059) and sponsored independently by the University of Leicester (reference: 0746). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.