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

作者：M. Tian, V. Ajay, Danzeng Dunzhu, Safraj Shahul Hameed, Xian Li, Zhong Liu, Cong Li, Hao Chen, KaWing Cho, Ruilai Li, Xing-Shan Zhao, Devraj Jindal, Ishita Rawal, Mohammed K. Ali, E. Peterson, Jiachao Ji, R. Amarchand, A. Krishnan, N. Tandon, Li-Qun Xu, Yangfeng Wu, D. Prabhakaran, Lijing L. Yan · 发表于：Circulation · 年份：2015 · DOI：10.1161/circulationaha.115.015373 · 被引用次数：147 · 研究领域：Medicine

Background— In rural areas in China and India, the cardiovascular disease burden is high but economic and healthcare resources are limited. This study (the Simplified Cardiovascular Management Study [SimCard]) aims to develop and evaluate a simplified cardiovascular management program delivered by community health workers 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). Recruited for the study were 2086 individuals with high cardiovascular risk (aged ≥40 years with self-reported history of coronary heart disease, stroke, diabetes mellitus, and/or measured systolic blood pressure ≥160 mm Hg). Participants in the intervention villages were managed by community health workers through an Android-powered app on a monthly basis focusing on 2 medication use and 2 lifestyle modifications. In comparison 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 antihypertensive 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 mm Hg; P=0.04). However, no significant changes were observed in the lifestyle factors. The intervention was culturally tailored, and country-specific results reveal...