TY - JOUR AU - Tandon N. AU - Chen H. AU - Liu Z. AU - Krishnan A. AU - Wu Y. AU - Prabhakaran D. AU - Li R. AU - Zhao X. AU - Li C. AU - Li X. AU - Yan L. AU - Dunzhu D. AU - Ali M. AU - Tian M AU - Amarchand R. AU - Peterson E. AU - Ajay V. AU - Hameed S. AU - Cho K. AU - Jindal D. AU - Rawal I. AU - Ji J. AU - Xu L. AB -

BACKGROUND: -In rural areas in China and India, cardiovascular disease burden is high but economic and healthcare resources are limited. This study aims to develop and evaluate a simplified cardiovascular management program (SimCard) delivered by community health workers (CHWs) 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). 2,086 'high cardiovascular risk' individuals (aged 40 years or older with self-reported history of coronary heart disease, stroke, diabetes, and/or measured systolic blood pressure >/=160 mmHg) were recruited. Participants in the intervention villages were managed by CHWs through an Android-powered "app" on a monthly basis focusing on two medication use and two lifestyle modifications. Compared 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 anti-hypertensive 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 mmHg, 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 potential impacts on mortality and morbidity outcomes. Clinical Trial Registration Information-clinicaltrials.gov. Identifier: NCT01503814.

AD - The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
Public Health Foundation of India, New Delhi, India & Centre for Chronic Disease Control, New Delhi, India.
Tibet University, Lhasa, China.
Public Health Foundation of India, New Delhi, India.
The George Institute for Global Health at Peking University Health Science Center, Beijing, China & Peking University School of Public Health, Beijing, China.
Beijing Hospital, Beijing, China.
Children's Hospital Los Angeles, CA.
Jishuitan Hospital, Beijing, China.
Centre for Chronic Disease Control, New Delhi, India.
Rollins School of Public Health, Emory University, Atlanta, GA.
Duke Clinical Research Institute and Duke University Medical Center, Durham, NC.
All India Institute of Medical Sciences, New Delhi, India.
China Mobile Research Institute, Beijing, China.
The George Institute for Global Health at Peking University Health Science Center, Beijing, China & Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China lyan@georgeinstitute.org.cn. AN - 26187183 BT - Circulation DP - NLM ET - 2015/07/19 LA - Eng LB - CHINA N1 - Tian, Maoyi
Ajay, Vamadevan
Dunzhu, Danzeng
Hameed, Safraj
Li, Xian
Liu, Zhong
Li, Cong
Chen, Hao
Cho, KaWing
Li, Ruilai
Zhao, Xingshan
Jindal, Devraj
Rawal, Ishita
Ali, Mohammed K
Peterson, Eric D
Ji, Jiachao
Amarchand, Ritivik
Krishnan, Anand
Tandon, Nikhil
Xu, Li-Qun
Wu, Yangfeng
Prabhakaran, Dorairaj
Yan, Lijing
Circulation. 2015 Jul 17. pii: CIRCULATIONAHA.115.015373. N2 -

BACKGROUND: -In rural areas in China and India, cardiovascular disease burden is high but economic and healthcare resources are limited. This study aims to develop and evaluate a simplified cardiovascular management program (SimCard) delivered by community health workers (CHWs) 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). 2,086 'high cardiovascular risk' individuals (aged 40 years or older with self-reported history of coronary heart disease, stroke, diabetes, and/or measured systolic blood pressure >/=160 mmHg) were recruited. Participants in the intervention villages were managed by CHWs through an Android-powered "app" on a monthly basis focusing on two medication use and two lifestyle modifications. Compared 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 anti-hypertensive 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 mmHg, 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 potential impacts on mortality and morbidity outcomes. Clinical Trial Registration Information-clinicaltrials.gov. Identifier: NCT01503814.

PY - 2015 SN - 1524-4539 (Electronic)
0009-7322 (Linking) T2 - Circulation TI - 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 Y2 - FY16 ER -