Risk factors

Waiting rooms are the best place to practice preventive cardiology


The waiting areas of cardiology clinics are an overlooked and effective environment for offering educational interventions to reduce cardiovascular risk factors, Australian research shows.

The While You Wait study offered educational interventions to cardiac patients attending the Rapid Access Clinic at Sydney’s Westmead Hospital focusing on issues such as physical activity, medications, diet, hypertension, and how to perform CPR.

Conducted as a randomised trial, 220 patients in the waiting room were provided with videos  on a tablet, tailored to their risk factor profile, and their outcomes were compared to a control group of 110 patients who received usual care.

When assessed immediately after attending the cardiology clinic, patients who received the education intervention had a significantly higher motivation to improve cardiovascular risk-modifying behaviours compared to the control group (29.6% vs 8.7%, relative risk 1.63).

The impact was most apparent in patients who watched two or more educational videos.

Similarly, patients who received the CPR video to watch while waiting reported greater knowledge, willingness and confidence to perform CPR, (RR 1.61) after the clinic visit than those who did not.

When followed up over the next 30 days, a high proportion of participants reported achieving diet and physical activity targets increased (16.1% vs 24.8%, OR=2.44; however, there was no significant difference between groups at 30 days.

The higher CPR knowledge was maintained at 30 days but rates of confidence were similar to those of the control group at this time.

Patients who had the waiting room educational intervention also reported significantly higher satisfaction with their clinic visit.

Subgroup analysis suggested females were more likely to achieve the primary outcome of changing cardiovascular risk factors than males.

The study investigators said the While You Wait trial showed there was great potential for an educational intervention that was simple and low cost to implement and which could be scaled up easily.

“Using time otherwise not used effectively during patient care makes good clinical sense, and if it empowers patients to understand and self-manage their condition is likely to have additional health and economic benefits,” they wrote.

They suggested the impact of the initial waiting room education could be boosted with follow up interventions offering further access to videos and/or the delivery of mobile health strategies .

“The large immediate intervention effect on motivation shown in our study could also be harnessed to engage patients in longer term behaviour change interventions. Taking the opportunity of the clinic visit to commence them on this journey is a potentially useful opportunistic intervention,” they said

“Waiting time is increasing, underused and presents an opportunity for the delivery of interventions to improve patient engagement and health outcomes … Delivered at a population level, the intervention may offer a cost-effective approach to provision of CVD and chronic disease preventative programmes,” they concluded.

The findings are published in Heart journal.

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