Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)

Janusz Kaczorowski, Larry W Chambers, Lisa Dolovich, J Michael Paterson, Tina Karwalajtys, Tracy Gierman, Barbara Farrell, Beatrice McDonough, Lehana Thabane, Karen Tu, Brandon Zagorski, Ron Goeree, Cheryl A Levitt, William Hogg, Stephanie Laryea, Megan Ann Carter, Dana Cross, Rolf J Sabaldt, Janusz Kaczorowski, Larry W Chambers, Lisa Dolovich, J Michael Paterson, Tina Karwalajtys, Tracy Gierman, Barbara Farrell, Beatrice McDonough, Lehana Thabane, Karen Tu, Brandon Zagorski, Ron Goeree, Cheryl A Levitt, William Hogg, Stephanie Laryea, Megan Ann Carter, Dana Cross, Rolf J Sabaldt

Abstract

Objective: To evaluate the effectiveness of the community based Cardiovascular Health Awareness Program (CHAP) on morbidity from cardiovascular disease.

Design: Community cluster randomised trial.

Setting: 39 mid-sized communities in Ontario, Canada, stratified by location and population size.

Participants: Community dwelling residents aged 65 years or over, family physicians, pharmacists, volunteers, community nurses, and local lead organisations.

Intervention: Communities were randomised to receive CHAP (n = 20) or no intervention (n = 19). In CHAP communities, residents aged 65 or over were invited to attend volunteer run cardiovascular risk assessment and education sessions held in community based pharmacies over a 10 week period; automated blood pressure readings and self reported risk factor data were collected and shared with participants and their family physicians and pharmacists.

Main outcome measure: Composite of hospital admissions for acute myocardial infarction, stroke, and congestive heart failure among all community residents aged 65 and over in the year before compared with the year after implementation of CHAP.

Results: All 20 intervention communities successfully implemented CHAP. A total of 1265 three hour long sessions were held in 129/145 (89%) pharmacies during the 10 week programme. 15,889 unique participants had a total of 27,358 cardiovascular assessments with the assistance of 577 peer volunteers. After adjustment for hospital admission rates in the year before the intervention, CHAP was associated with a 9% relative reduction in the composite end point (rate ratio 0.91, 95% confidence interval 0.86 to 0.97; P = 0.002) or 3.02 fewer annual hospital admissions for cardiovascular disease per 1000 people aged 65 and over. Statistically significant reductions favouring the intervention communities were seen in hospital admissions for acute myocardial infarction (rate ratio 0.87, 0.79 to 0.97; P = 0.008) and congestive heart failure (0.90, 0.81 to 0.99; P = 0.029) but not for stroke (0.99, 0.88 to 1.12; P = 0.89).

Conclusions: A collaborative, multi-pronged, community based health promotion and prevention programme targeted at older adults can reduce cardiovascular morbidity at the population level. Trial registration Current controlled trials ISRCTN50550004.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that none of the authors has financial interests that may be relevant to the submitted work

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4788013/bin/kacj799502.f1_default.jpg
Profile of CHAP trial, including main components of intervention. CHAP=Cardiovascular Health Awareness Program

References

    1. Rodgers A, Vaughan P, Prentice T, Edejer TT-T, Evans D. The world health report 2002. WHO, 2002.
    1. World Health Organization. Preventing chronic disease: a vital investment. WHO, 2005.
    1. Lawes CM, Vander Hoorn S, Rodgers A, International Society of Hypertension. Global burden of blood-pressure related disease, 2001. Lancet 2008;371:1513-8.
    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747-57.
    1. Manuel DG, Lim J, Tanuseputro P, Anderson GM, Alter DA, Laupacis A, et al. Revisiting Rose: strategies for reducing coronary heart disease. BMJ 2006;332:659-62.
    1. World Health Organization. Prevention of recurrent heart attacks and strokes in low and middle income populations: evidence-based recommendations for policy makers and health professionals. WHO, 2003.
    1. Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D’Agostino RB, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham Heart Study. JAMA 2002;287:1003-10.
    1. Pennant M, Davenport C, Bayliss S, Greenheld W, Marshall T, Hyde C. Community programs for the prevention of cardiovascular disease: a systematic review. Am J Epidemiol 2010;172:501-16.
    1. Karwalajtys T, McDonough B, Hall H, Guirguis-Younger M, Chambers LW, Kaczorowski J, et al. Development of the volunteer peer educator role in a community Cardiovascular Health Awareness Program (CHAP): a process evaluation in two communities. J Community Health 2009;34:336-45.
    1. Kaczorowski J, Chambers LW, Karwalajtys T, Dolovich L, Farrell B, McDonough B, et al. Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians. Prev Med 2008;46:537-44.
    1. Chambers LW, Kaczorowski J, Dolovich L, Karwalajtys T, Hall HL, McDonough B, et al. A community-based program for cardiovascular health awareness. Can J Public Health 2005;96:294-8.
    1. Jones C, Simpson SH, Mitchell D, Haggarty S, Campbell N, Then K, et al. Enhancing hypertension awareness and management in the elderly: lessons learned from the Airdrie Community Hypertension Awareness and Management Program (A-CHAMP). Can J Cardiol 2008;24:561-7.
    1. Carter M, Karwalajtys T, Chambers L, Kaczorowski J, Dolovich L, Gierman T, et al. Implementing a standardized community-based cardiovascular risk assessment program in 20 Ontario communities. Health Promot Int 2009;24:325-33.
    1. Thomson O’Brien MA, Oxman AD, Haynes RB, Davis DA, Freemantle N, Harvey EL. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2000;2:CD000125.
    1. Austin PC, Daly PA, Tu JV. A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario. Am Heart J 2002;144:290-6.
    1. Lee DS, Donovan L, Austin PC, Gong Y, Liu PP, Rouleau JL, et al. Comparison of coding of heart failure and comorbidities in administrative and clinical data for use in outcomes research. Med Care 2005;43:182-8.
    1. Tirschwell DL, Longstreth WT Jr. Validating administrative data in stroke research. Stroke 2002;33:2465-70.
    1. Humphries KH, Rankin JM, Carere RG, Buller CE, Kiely FM, Spinelli JJ. Co-morbidity data in outcomes research: are clinical data derived from administrative databases a reliable alternative to chart review? J Clin Epidemiol 2000;53:343-9.
    1. Tu K, Mamdani MM, Tu JV. Hypertension guidelines in elderly patients: is anybody listening? Am J Med 2002;113:52-8.
    1. Kralj B. Measuring “rurality” for the purposes of health care planning: an empirical measure for Ontario. Ont Med Rev 2000;67:33-52.
    1. Johns Hopkins University School of Hygiene and Public Health. Johns Hopkins University ACG case-mix adjustment system [computer program]. Johns Hopkins University School of Hygiene and Public Health, 1997.
    1. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288-94.
    1. Hux JE, Ivis F, Flintoft V, Bica A. Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 2002;25: 512-6.
    1. McCullough PA, Philbin EF, Spertus JA, Kaatz S, Sandberg KR, Weaver WD. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 2002;39:60-9.
    1. Parker DR, Assaf AR. Community interventions for cardiovascular disease. Prim Care 2005;32:865-81.
    1. Rose G. The strategy of preventive medicine. Oxford University Press, 1992.
    1. Thompson BT, Coronado G, Snipes SA, Puschel K. Methodological advances and ongoing challenges in designing community based health promotion programs. Annu Rev Public Health 2003;24:315-40.
    1. Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010;362:590-9.
    1. Mackay DF, Irfan MO, Haw S, Pell JP. Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events. Heart 2010;96:1525-30.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner