Document Detail

Rationale and design of a randomized controlled trial evaluating community health worker-based interventions for the secondary prevention of acute coronary syndromes in India (SPREAD).
MedLine Citation:
PMID:  25440797     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: There is a need to evaluate and implement cost-effective strategies to improve adherence to treatments in coronary heart disease. There are no studies from low- to middle income countries (LMICs) evaluating trained community health worker (CHW)-based interventions for the secondary prevention of coronary heart disease.
METHODS: We designed a hospital-based, open randomized trial of CHW-based interventions versus standard care. Patients after an acute coronary syndrome (ACS) were randomized to an intervention group (a CHW-based intervention package, comprising education tools to enhance self-care and adherence, and regular follow-up by the CHW) or to standard care for 12months during which study outcomes were recorded. The CHWs were trained over a period of 6months. The primary outcome measure was medication adherence. The secondary outcomes were differences in adherence to lifestyle modification, physiological parameters (blood pressure [BP], body weight, body mass index [BMI], heart rate, lipids), and major adverse cardiovascular events.
RESULTS: We recruited 806 patients stabilized after an ACS from 14 hospitals in 13 Indian cities. The mean age was 56.4 (±11.32) years, and 17.2% were females. A high prevalence of risk factors such as hypertension (43.4%), diabetes (31.9%), tobacco consumption (35.4%), and inadequate physical activity (70.5%) was documented. A little over half had ST-elevation myocardial infarction (53.7%), and 46.3% had non-ST-elevation myocardial infarction or unstable angina.
CONCLUSION: The CHW interventions and training for SPREAD have been developed and adapted for local use. The results and experience of this study will be important to counter the burden of cardiovascular diseases in low- to middle income countries.
Deepak Y Kamath; Denis Xavier; Rajeev Gupta; P J Devereaux; Alben Sigamani; Tanvir Hussain; Sowmya Umesh; Freeda Xavier; Preeti Girish; Nisha George; Tinku Thomas; N Chidambaram; Rajnish Joshi; Prem Pais; Salim Yusuf
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Publication Detail:
Type:  Journal Article     Date:  2014-08-10
Journal Detail:
Title:  American heart journal     Volume:  168     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-12-02     Completed Date:  -     Revised Date:  2014-12-04    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  690-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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