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The aim of this pragmatic trial was to assess the effectiveness of a multiple risk factor intervention in changing <jats:styled-content style=\"fixed-case\">CPOU<\/jats:styled-content> patients' health beliefs and readiness to change health behaviors. A secondary aim was to obtain preliminary estimates of the intervention's effect on diet, physical activity, and smoking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a pilot randomized controlled trial of a moderate\u2010intensity counseling intervention that aimed to build motivation to change and problem\u2010solving skills in 140 adult patients with at least one modifiable cardiovascular risk factor (<jats:styled-content style=\"fixed-case\">CRF<\/jats:styled-content>) who were admitted to the <jats:styled-content style=\"fixed-case\">CPOU<\/jats:styled-content> of an academic emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) with symptoms of possible acute coronary syndrome. Study patients were randomly assigned to full counseling (face\u2010to\u2010face cardiovascular risk assessment and personalized counseling on nutrition, physical activity, and smoking cessation in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>, plus two telephone follow\u2010up sessions) or minimal counseling (brief instruction [&lt;5 minutes] on benefits of modifying cardiovascular risk factors) by a cardiac rehabilitation specialist. We measured Health Belief Model constructs for ischemic heart disease, stage of change, and self\u2010reported <jats:styled-content style=\"fixed-case\">CRF<\/jats:styled-content>\u2010related behaviors (diet, exercise, and smoking) during 6\u2010month follow\u2010up using previously validated measures. We used linear mixed models and logistic regression (with generalized estimating equations) to compare continuous and dichotomous behavioral outcomes across treatment arms, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Approximately 20% more patients in the full counseling arm reported having received counseling on diet and physical activity during <jats:styled-content style=\"fixed-case\">CPOU<\/jats:styled-content> admission, compared to the minimal counseling arm; a similar proportion of patients in both counseling arms reported having received advice or assistance in quitting smoking. There were no significant differences between treatment arms for any cardiovascular health beliefs, readiness to change, or <jats:styled-content style=\"fixed-case\">CRF<\/jats:styled-content>\u2010related behaviors during longitudinal follow\u2010up. In secondary analyses in both treatment arms combined, however, patients showed significant differences between follow\u2010up and baseline measurements: increases in the perceived benefits of improving <jats:styled-content style=\"fixed-case\">CRF<\/jats:styled-content>\u2010related behaviors (27.7 vs. 26.6 on a scale from 7 to 35, p = 0.0001) and increased readiness to change dietary behavior and physical activity during follow\u2010up\u2014intake of saturated fat (83% vs. 49%), readiness to change fruit and vegetable consumption (83% vs 56%), and readiness to perform regular exercise (34% vs. 14%) at 6 months and baseline, respectively (p &lt; 0.0001 for all comparisons in both treatment arms combined).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A multiple risk factor intervention that focused on increasing motivation to change and problem\u2010solving skills did not significantly improve behavioral outcomes, compared to minimal counseling. Patients admitted to the <jats:styled-content style=\"fixed-case\">CPOU<\/jats:styled-content> demonstrated sustained changes in several cardiovascular health beliefs and risk\u2010related behaviors during follow\u2010up; this provides further evidence that the <jats:styled-content style=\"fixed-case\">CPOU<\/jats:styled-content> visit is a \u201cteachable moment\u201d for cardiovascular risk reduction. Future studies should evaluate the effectiveness of <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>\u2010initiated counseling interventions to engage patients in changing cardiovascular risk behaviors, in coordination with primary care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13231","type":"journal-article","created":{"date-parts":[[2017,7,27]],"date-time":"2017-07-27T07:58:39Z","timestamp":1501142319000},"page":"968-982","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Multiple Risk Factor Counseling to Promote Heart\u2010healthy Lifestyles in the Chest Pain Observation Unit: Pilot Randomized Controlled Trial"],"prefix":"10.1111","volume":"24","author":[{"given":"David A.","family":"Katz","sequence":"first","affiliation":[{"name":"Department of Medicine University of Iowa Carver College of Medicine Iowa City IA"},{"name":"Comprehensive Access &amp; Delivery Research and Evaluation (CADRE) Center Iowa City VA Medical Center Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Graber","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Lounsbury","sequence":"additional","affiliation":[{"name":"Cardiovascular Health, Assessment, Management, and Prevention Services University of Iowa Hospital and Clinics Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Vander Weg","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Iowa Carver College of Medicine Iowa City IA"},{"name":"Comprehensive Access &amp; Delivery Research and Evaluation (CADRE) Center Iowa City VA Medical Center Iowa City IA"},{"name":"Department of Psychological and Brain Sciences University of Iowa College of Liberal Arts Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily K.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Iowa Carver College of Medicine Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Clair","sequence":"additional","affiliation":[{"name":"Cardiovascular Health, Assessment, Management, and Prevention Services University of Iowa Hospital and Clinics Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip A.","family":"Horwitz","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Iowa Carver College of Medicine Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueya","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Iowa Carver College of Medicine Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences University of Iowa College of Liberal Arts Iowa City IA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,29]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary. 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