Community-based Care Model Reduces CVD Risk


Intervention of friends, family, and non-physician health workers is key.

Heart health

Friends, family, and non-physician health workers (NPHWs) can make a dramatic difference in reducing the risk factors for heart problems in patients with hypertension, according to a new international study.

People with new or poorly controlled hypertension given an integrated and comprehensive intervention by non-physician health workers along with personal supporters over a year had a reduction in cardiovascular risk of more than 40% compared to usual care, according to the study.

“There was a doubling in blood pressure control, with reductions in low-density lipoprotein (LDL) cholesterol, and improvements in medication adherence, physical activity, and diet,” says lead author Jon-David Schwalm, MD, of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.

The study results were part of a presentation at the European Society of Cardiology Congress with the World Congress of Cardiology in Paris, France, earlier this month and are also being published in The Lancet. The clinical trial, called Heart Outcomes Prevention and Evaluation 4 (HOPE 4), is led by PHRI.

Hypertension is the leading cause of cardiovascular disease worldwide, with the majority of the burden in low- and middle-income countries. Although there are clear benefits and recommendations for the use of antihypertensive medications and statins in patients with hypertension, control of blood pressure and use of statins in these countries is very low.

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The study involved 1,371 people age 50 years or older from 30 communities in Colombia and Malaysia. Participants in 16 communities received usual care, and those in 14 communities had an intervention that included: the initiation and monitoring of treatments and controlling risk factors by NPHWs using computer tablet-based management algorithms and counseling; the provision of free antihypertensive and statin medicines recommended by NPHWs under supervision of physicians; and the involvement of a friend or family member to support adherence to medications and lifestyle advice.

“Previous studies with NPHWs led to modest effects on cardiovascular risk factors. We tested whether an intervention involving NPHWs, general practitioners and family, with provision of evidence-based medications, can safely and substantially reduce individual cardiovascular risk, and found it successful,” says Schwalm, an associate professor of medicine at McMaster, a scientist at the PHRI and an interventional cardiologist.

Salim Yusuf, principal investigator of the study and PHRI executive director, added that the research results have global impact.

“This strategy is pragmatic, effective, and scalable, and has the potential to substantially reduce cardiovascular disease globally, compared to current methods that are solely physician-based,” he says. “Adopting or adapting the HOPE 4 strategy in different countries to better control hypertension and reduce other risk factors could help achieve the United Nations’ target for a one-third reduction in premature cardiovascular mortality by 2030.”

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