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A Cluster-Randomized, Controlled Trial of a Simplified Multifaceted Management Program for Individuals at High
Maoyi Tian1, Vamadevan S Ajay1, Danzeng Dunzhu1
1From The George Institute for Global Health at Peking University Health Science Center, Beijing, China (M.T., X.L., C.L., R.L., J.J., Y.W., L.L.Y.); Public Health Foundation of India, New Delhi, India (V.S.A., S.S.H., D.P.); Centre for Chronic Disease Control, New Delhi, India (V.S.A., D.J., I.R., D.P.); Tibet University, Lhasa, China (D.D., Z.L.); Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (C.L., Y.W.); Department of Cardiology, Beijing Hospital, China (H.C.); Children's Hospital Los Angeles, CA (K.W.C.); Department of Cardiology, Jishuitan Hospital, Beijing, China (X.Z.); Rollins School of Public Health, Emory University, Atlanta, GA (M.K.A.); Duke Clinical Research Institute, Duke University, Durham, NC (E.D.P.); Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India (R.A., A.K.); Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.); China Mobile Research Institute, Beijing, China (L.X.); and Duke Global Health Institute, and Global Health Research Center, Duke Kunshan University, Kunshan, China (L.L.Y.).
A simplified cardiovascular management program using a smartphone app improved medication adherence and reduced blood pressure in rural China and India. This approach enhances primary care quality in resource-limited settings.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Digital Health
Background:
- High cardiovascular disease burden in rural China and India with limited resources.
- Need for innovative, cost-effective healthcare solutions.
- Development of the Simplified Cardiovascular Management Study (SimCard).
Purpose of the Study:
- To develop and evaluate a simplified cardiovascular management program.
- To assess the program's effectiveness delivered by community health workers using a smartphone-based decision support system.
- To improve cardiovascular disease management in resource-poor settings.
Main Methods:
- Yearlong cluster-randomized controlled trial in 47 villages across China and India.
- Recruitment of 2086 high-risk individuals (≥40 years).
- Intervention group managed monthly via an Android app focusing on medication and lifestyle modifications.
Main Results:
- Significant increase in antihypertensive medication use (25.5%; P<0.001).
- Significant increase in aspirin use (17.1%; P<0.001) and reduction in systolic blood pressure (-2.7 mm Hg; P=0.04).
- No significant changes observed in lifestyle factors; country-specific differences noted.
Conclusions:
- The simplified program improved primary care quality and clinical outcomes in resource-poor settings.
- Culturally tailored interventions are crucial for regional effectiveness.
- Further large-scale trials are needed to assess impacts on mortality and morbidity.
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