Abstract 021: The Effectiveness of a Community Health Worker-Led Intensive Blood Pressure Intervention on Coronary Heart Disease and Heart Failure
Abstract
Background: Coronary heart disease (CHD) and heart failure are increasing in China and represent significant public health and economic challenges. Although community health worker (CHW)-led interventions have shown effectiveness in blood pressure (BP) control within low-resource environments, their impact on CHD and heart failure is yet to be fully documented. Objectives: This study estimated the effectiveness of a CHW-led intensive BP intervention on risk of myocardial infarction and heart failure. Methods: The China Rural Hypertension Control Project (CRHCP) included 33,995 hypertensive patients from 326 villages in rural China. We randomly assigned 163 villages to a non-physician community healthcare provider-led intervention and 163 villages to usual care. In the intervention group, trained non-physician community healthcare providers (NPCHPs) initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic BP (SBP) goal of <130 mmHg and a diastolic BP (DBP) goal of <80 mmHg, with supervision from primary care physicians. The primary outcomes were myocardial infarction and heart failure, with secondary analyses exploring fatal and nonfatal myocardial infarction. Results: Over 48 months, the net reduction in SBP was 22.0 mmHg (95% CI: 20.6-23.4) and in DBP was 9.3 mmHg (8.7-10.0) in the intervention group compared to usual care. During follow-up, we observed 174 myocardial infarction events (0.26% yearly rate) in intervention compared to 204 (0.32% yearly rate) in usual care participants. The NPCHP-led intervention demonstrated a 19% reduction in myocardial infarction (HR=0.81; 95% CI: 0.67-0.99). Notably, nonfatal myocardial infarction was reduced by 23% (HR=0.77; 0.62-0.96), although no significant reduction was observed for fatal events (HR=0.88; 0.63-1.53). For heart failure, we observed 107 events (0.16% yearly rate) in the intervention group compared to 147 (0.23% yearly rate) in usual care group, corresponding to a 32% reduction in heart failure (HR=0.68; 0.54-0.85). Conclusion: This study provides compelling evidence that intensive BP control, led by NPCHPs, is effective at reducing CHD and heart failure among rural residents in China. This NPCHP-led intervention is both cost-effective and feasible for implementation in low-resource settings. These findings support the scale-up of the CRHCP intervention across low- and middle-income countries to reduce the global burden of CHD and heart failure.
Article Details
Authors (13)
Farah Allouch
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans
Katherine Mills
TULANE UNIVERSITY, New Orleans, Louisiana, United States
Guozhe Sun
Department of Cardiology, The First Hospital of China Medical University, Shenyang (Y.S., G.S., S.Z., X.G.).
Ning Ye
State Key Laboratory of Crystal Materials, Tianjin Key Laboratory of Functional Crystal Materials, Institute of Functional Crystal, College of Materials Science and Engineering
Xiaofan Guo
Department of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh
Lixia Qiao
First Hospital of China Medical University, Shenyang, Liaoning, China
Nanxiang Ouyang
First Hospital of China Medical University, Shenyang, Liaoning, China
Songyue Liu
Department of Materials Science and Engineering, Carnegie Mellon University , Pittsburgh, Pennsylvania 15213,
Wei Miao
Department of Nuclear Medicine First Affiliated Hospital of Anhui Medical University Hefei Anhui 230022 China
Yangzhi Yin
First Hospital of China Medical University, Shenyang, Liaoning, China
Ziyi Xie
Beijing National Laboratory for Molecular Science, Key Laboratory of Organic Solids, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
Jing Chen
Jiang He