Intervening on fear after acute cardiac events: Rationale and design of the INFORM randomized clinical trial

Jeffrey L. Birk*, Robin Cumella, David Lopez-Veneros, Ammie Jurado, Emily K. Romero, Amit Lazarov, Ian M. Kronish

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Many acute coronary syndrome (ACS) patients are nonadherent to cardiovascular medications despite their known benefits for lowering risk of recurrent cardiovascular events. Research suggests that greater cardiac-related fear of recurrence (FoR) may be associated with higher nonadherence to cardiovascular medications and avoidance of physical activity. We aim to test the effect of an intervention that targets FoR as a potentially modifiable mechanism underlying nonadherence to recommended health behaviors among patients with suspected ACS. Method: The INFORM trial ("INvestigating Fear Of Recurrence as a modifiable Mechanism of behavior change to improve medication adherence in acute coronary syndrome patients") is a double-blind, parallel-group randomized clinical trial. It compares an 8-session, at-home, electronic tablet-delivered, cognitive bias modification training (CBMT) intervention with a sham control. Patients who experience high perceived threat at the time of presentation to the emergency department (ED) with a suspected ACS are enrolled and randomized within 6 weeks of their ED visit. The primary outcome, FoR, is measured by the adapted Concerns about Recurrent ACS Scale. The trial also tests the intervention's effect on a potential mechanism of health behavior change that is inversely correlated with fear: an expansive future time perspective. Additional outcomes include electronically measured adherence to a cardiovascular medication and self-reported physical activity. Conclusions: This study takes a mechanistic approach to addressing the dangerous problem of poor health behaviors after ACS. The trial will test whether targeting FoR or future time perspective by CBMT is a promising approach to improving nonadherence after ACS.

Original languageEnglish
Pages (from-to)736-744
Number of pages9
JournalHealth Psychology
Issue number9
StatePublished - Sep 2020


  • Acute coronary syndrome
  • Cognitive bias modification
  • Fear of recurrence
  • Medication adherence
  • Randomized clinical trial


Dive into the research topics of 'Intervening on fear after acute cardiac events: Rationale and design of the INFORM randomized clinical trial'. Together they form a unique fingerprint.

Cite this