Purpose Despite evidence of myocardial infarct size reduction in animal studies, remote ischaemic conditioning (RIC) failed to improve clinical outcomes in the large CONDI-2/ERIC-PPCI trial. Potential reasons include that the predominantly low-risk study participants all received timely optimal reperfusion therapy by primary percutaneous coronary intervention (PPCI). Whether RIC can improve clinical outcomes in higher-risk STEMI patients in environments with poor access to early reperfusion or PPCI will be investigated in the RIC-AFRICA trial. Methods The RIC-AFRICA study is a sub-Saharan African multi-centre, randomized, double-blind, sham-controlled clinical trial designed to test the impact of RIC on the composite endpoint of 30-day mortality and heart failure in 1200 adult STEMI patients without access to PPCI. Randomized participants will be stratified by whether or not they receive thrombolytic therapy within 12 h or arrive outside the thrombolytic window (12–24 h). Participants will receive either RIC (four 5-min cycles of inflation [20 mmHg above systolic blood pressure] and deflation of an automated blood pressure cuff placed on the upper arm) or sham control (similar protocol but with low-pressure inflation of 20 mmHg and deflation) within 1 h of thrombolysis and applied daily for the next 2 days. STEMI patients arriving greater than 24 h after chest pain but within 72 h will be recruited to participate in a concurrently running independent observational arm. Conclusion The RIC-AFRICA trial will determine whether RIC can reduce rates of death and heart failure in higher-risk sub-optimally reperfused STEMI patients, thereby providing a low-cost, non-invasive therapy for improving health outcomes.
Background: The prevalence of non-communicable diseases (NCDs) and physical inactivity are concerning within the South African population. To address these concerns, the ‘Strategic Plan for Prevention and Control of NCDs 2013-2017’ was developed. In response to this plan, a 12-week pilot biokinetics community health programme, Sweet Hearts, was initiated. Methods: This study is a prospective pilot study evaluating the feasibility and effectiveness of the intervention. Twenty- five individuals participated in the intervention. Ten participants performed a battery of physiological tests pre and post intervention and 5 participants completed an email-based survey post intervention. The setting of the study was Tramway Football Club, Southfield, Cape Town, South Africa. The Sweet Hearts intervention was designed to promote physical activity and healthy nutritional habits in those who participated. A total of 27 exercise sessions consisting of cardiovascular, resistance and flexibility training were conducted. Brief-behavioural counselling was integrated into exercise sessions. Results: The intervention group had a high attrition rate with >50% of participants not presenting for post-intervention testing. Results were evident despite a limited sample size. There were significant improvements in health outcome measures among participants who did attend all testing sessions. These improvements included: an increase in Global Physical Activity Questionnaire (GPAQ) score (p = 0.03), 12- minute walk distance (p = 0.01), sit-to-stand test repetitions (p = 0.001), and a decrease in waist circumference (p = 0.01). Improvements were also noted in self-reported eating restraint (p = 0.03). Five main themes were structured into post intervention surveys: 1) enjoyment of the intervention, 2) benefits of the intervention, 3) obstacles affecting adherence, 4) future improvements to the intervention, and 5) state of non-communicable diseases in South Africa. Conclusion: The results of the Sweet Hearts intervention demonstrate the difficulty and importance of maintaining adherence to a community health intervention. The favourable results of the small sample size demonstrate the potential benefit of biokinetics-based programmes in the public health sector; and provide proof of concept for the dedication of resources towards health promotion within a community setting.
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