Aditya Khetan1, Melissa Zullo2, Anitha Rani3, Rishab Gupta4, Raghunandan Purushothaman4, Navkaranbir S Bajaj5, Sushil Agarwal4, Sri Krishna Madan Mohan6, Richard Josephson2. 1. Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA; SEHAT, Dalkhola, India. Electronic address: dradityakhetan@gmail.com. 2. Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA; School of Public Health, Kent State University, Kent, OH, USA. 3. Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Porur, India. 4. SEHAT, Dalkhola, India. 5. Division of Cardiovascular Disease, Department of Internal Medicine and Radiology, University of Alabama, Birmingham, AL, USA. 6. Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
Abstract
BACKGROUND: Eighty percent of premature mortality from cardiovascular disease occurs in low- and middle-income countries. Hypertension, diabetes, and smoking are the top risk factors causing this disease burden. OBJECTIVES: The study aimed to test the hypothesis that utilizing community health workers (CHWs) to manage hypertension, diabetes and smoking in an integrated manner would lead to improved control of these conditions. METHODS: This was a 2-year cluster (n = 12) randomized controlled trial of 3,556 adults (35 to 70 years of age) in a single town in India, who were screened at home for hypertension, diabetes, and smoking. Of these adults, 1,242 (35%) had at least 1 risk factor (hypertension = 650, diabetes = 317, smoking = 500) and were enrolled in the study. The intervention group had behavioral change communication through regular home visits from community health workers. The control group received usual care in the community. The primary outcomes were changes in systolic blood pressure, fasting blood glucose, and average number of cigarettes/bidis smoked daily among individuals with respective risk factors. RESULTS: The mean ± SD change in systolic blood pressure at 2 years was -12.2 ± 19.5 mm Hg in the intervention group as compared with -6.4 ± 26.1 mm Hg in the control group, resulting in an adjusted difference of -8.9 mm Hg (95% confidence interval [CI]: -3.5 to -14.4 mm Hg; p = 0.001). The change in fasting blood glucose was -43.0 ± 83.5 mg/dl in the intervention group and -16.3 ± 77.2 mg/dl in the control group, leading to an adjusted difference of -21.3 mg/dl (95% CI: 18.4 to -61 mg/dl; p = 0.29). The change in mean number of cigarettes/bidis smoked was nonsignificant at +0.2 cigarettes/bidis (95% CI: 5.6 to -5.2 cigarettes/bidis; p = 0.93). CONCLUSIONS: A population-based strategy of integrated risk factor management through community health workers led to improved systolic blood pressure in hypertension, an inconclusive effect on fasting blood glucose in diabetes, and no demonstrable effect on smoking. (Study of a Community-Based Approach to Control Cardiovascular Risk Factors in India [SEHAT]; NCT02115711).
RCT Entities:
BACKGROUND: Eighty percent of premature mortality from cardiovascular disease occurs in low- and middle-income countries. Hypertension, diabetes, and smoking are the top risk factors causing this disease burden. OBJECTIVES: The study aimed to test the hypothesis that utilizing community health workers (CHWs) to manage hypertension, diabetes and smoking in an integrated manner would lead to improved control of these conditions. METHODS: This was a 2-year cluster (n = 12) randomized controlled trial of 3,556 adults (35 to 70 years of age) in a single town in India, who were screened at home for hypertension, diabetes, and smoking. Of these adults, 1,242 (35%) had at least 1 risk factor (hypertension = 650, diabetes = 317, smoking = 500) and were enrolled in the study. The intervention group had behavioral change communication through regular home visits from community health workers. The control group received usual care in the community. The primary outcomes were changes in systolic blood pressure, fasting blood glucose, and average number of cigarettes/bidis smoked daily among individuals with respective risk factors. RESULTS: The mean ± SD change in systolic blood pressure at 2 years was -12.2 ± 19.5 mm Hg in the intervention group as compared with -6.4 ± 26.1 mm Hg in the control group, resulting in an adjusted difference of -8.9 mm Hg (95% confidence interval [CI]: -3.5 to -14.4 mm Hg; p = 0.001). The change in fasting blood glucose was -43.0 ± 83.5 mg/dl in the intervention group and -16.3 ± 77.2 mg/dl in the control group, leading to an adjusted difference of -21.3 mg/dl (95% CI: 18.4 to -61 mg/dl; p = 0.29). The change in mean number of cigarettes/bidis smoked was nonsignificant at +0.2 cigarettes/bidis (95% CI: 5.6 to -5.2 cigarettes/bidis; p = 0.93). CONCLUSIONS: A population-based strategy of integrated risk factor management through community health workers led to improved systolic blood pressure in hypertension, an inconclusive effect on fasting blood glucose in diabetes, and no demonstrable effect on smoking. (Study of a Community-Based Approach to Control Cardiovascular Risk Factors in India [SEHAT]; NCT02115711).
Authors: Kamran Siddiqi; Amir Khan; Maqsood Ahmad; Omara Dogar; Mona Kanaan; James N Newell; Heather Thomson Journal: Ann Intern Med Date: 2013-05-07 Impact factor: 25.391
Authors: Thomas A Gaziano; Shafika Abrahams-Gessel; Catalina A Denman; Carlos Mendoza Montano; Masuma Khanam; Thandi Puoane; Naomi S Levitt Journal: Lancet Glob Health Date: 2015-07-14 Impact factor: 26.763
Authors: Devin T Worster; Molly F Franke; Rodrigo Bazúa; Hugo Flores; Zulema García; Joanna Krupp; Jimena Maza; Lindsay Palazuelos; Katia Rodríguez; Patrick M Newman; Daniel Palazuelos Journal: BMJ Open Date: 2020-03-08 Impact factor: 2.692
Authors: David Flood; Jessica Hane; Matthew Dunn; Sarah Jane Brown; Bradley H Wagenaar; Elizabeth A Rogers; Michele Heisler; Peter Rohloff; Vineet Chopra Journal: PLoS Med Date: 2020-11-12 Impact factor: 11.613
Authors: Joseph Linju Maria; T N Anand; Boban Dona; Jose Prinu; Dorairaj Prabhakaran; Panniyammakal Jeemon Journal: Lancet Glob Health Date: 2020-11-23 Impact factor: 26.763