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.
Journal Article (Journal Article)
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.Full Text
Duke Authors
Cited Authors
- Tian, M; Ajay, VS; Dunzhu, D; Hameed, SS; Li, X; Liu, Z; Li, C; Chen, H; Cho, K; Li, R; Zhao, X; Jindal, D; Rawal, I; Ali, MK; Peterson, ED; Ji, J; Amarchand, R; Krishnan, A; Tandon, N; Xu, L-Q; Wu, Y; Prabhakaran, D; Yan, LL
Published Date
- September 2015
Published In
Volume / Issue
- 132 / 9
Start / End Page
- 815 - 824
PubMed ID
- 26187183
Pubmed Central ID
- PMC4558306
Electronic International Standard Serial Number (EISSN)
- 1524-4539
International Standard Serial Number (ISSN)
- 0009-7322
Digital Object Identifier (DOI)
- 10.1161/circulationaha.115.015373
Language
- eng