Circulation. 2015 Sep 1;132(9):815-24.

A Cluster-Randomized, Controlled Trial of a Simplified Multifaceted Management Program for Individuals at High Cardiovascular Risk (SimCard Trial) in Rural Tibet, China, and Haryana, India.

 

Tian M1, Ajay VS1, Dunzhu D1, Hameed SS1, Li X1, Liu Z1, Li C1, Chen H1, Cho K1, Li R1, Zhao X1, Jindal D1, Rawal I1, Ali MK1, Peterson ED1, Ji J1, Amarchand R1, Krishnan A1, Tandon N1, Xu LQ1, Wu Y1, Prabhakaran D2, Yan LL2.
  • 1From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children’s Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.).
  • 2From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children’s Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.). Lijing.Yan@Duke.edu dprabhakaran@phfi.org.

 

Abstract

BACKGROUND: In rural areas in China and India, the cardiovascular disease burden is high but economic and healthcare resources are limited. This study (the Simplified Cardiovascular Management Study [SimCard]) aims to develop and evaluate a simplified cardiovascular management program delivered by community health workers with the aid of a smartphone-based electronic decision support system.

METHODS AND RESULTS: The SimCard study was a yearlong cluster-randomized, controlled trial conducted in 47 villages (27 in China and 20 in India). Recruited for the study were 2086 individuals with high cardiovascular risk (aged ≥40 years with self-reported history of coronary heart disease, stroke, diabetes mellitus, and/or measured systolic blood pressure ≥160 mm Hg). Participants in the intervention villages were managed by community health workers through an Android-powered app on a monthly basis focusing on 2 medication use and 2 lifestyle modifications. In comparison with the control group, the intervention group had a 25.5% (P<0.001) higher net increase in the primary outcome of the proportion of patient-reported antihypertensive medication use pre- and post-intervention. There were also significant differences in certain secondary outcomes: aspirin use (net difference: 17.1%; P<0.001) and systolic blood pressure (-2.7 mm Hg; P=0.04). However, no significant changes were observed in the lifestyle factors. The intervention was culturally tailored, and country-specific results revealed important differences between the regions.

CONCLUSIONS: The results indicate that the simplified cardiovascular management program improved quality of primary care and clinical outcomes in resource-poor settings in China and India. Larger trials in more places are needed to ascertain the potential impacts on mortality and morbidity outcomes.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01503814.

KEYWORDS: China; India; cardiovascular diseases; community; decision support techniques; prevention & control

PMID: 26187183

 

 

 

 

 

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