The Rural Andhra Pradesh Cardiovascular Prevention Study (RAPCAPS)

Joshi, Rohina; Chow, Clara K; Raju, P. Krishnam; Raju, Krishnam; Gottumukkala, Arun Kumar; Reddy, K. Srinath; MacMahon, Stephen; Héritier, Stéphane; Li, Qiang; Dandona, Rakhi; Neal, Bruce

doi:10.1016/j.jacc.2011.10.901

Cited by 77 publications

(89 citation statements)

References 21 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, a recently concluded community-based cluster randomized trial did not show any improvements in the primary outcome of awareness about 6 lifestyle factors affecting CVD after a shorter period (18 months) of health promotion intervention by trained community health workers. 113 This may be because of a shorter period of intervention and the lack of an environment enabling the participants to change behavior. Therefore, innovative and context-specific primary prevention strategies need to be developed and tested in multiple settings.…”

Section: Cvd Prevention and Treatment Strategiesmentioning

confidence: 99%

Cardiovascular Diseases in India

2016

View full text Add to dashboard Cite

Abstract-Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India. A quarter of all mortality is attributable to CVD. Ischemic heart disease and stroke are the predominant causes and are responsible for >80% of CVD deaths. The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100 000 population in India is higher than the global average of 235 per 100 000 population. Some aspects of the CVD epidemic in India are particular causes of concern, including its accelerated buildup, the early age of disease onset in the population, and the high case fatality rate. In India, the epidemiological transition from predominantly infectious disease conditions to noncommunicable diseases has occurred over a rather brief period of time. Premature mortality in terms of years of life lost because of CVD in India increased by 59%, from 23.2 million (1990) to 37 million (2010). Despite wide heterogeneity in the prevalence of cardiovascular risk factors across different regions, CVD has emerged as the leading cause of death in all parts of India, including poorer states and rural areas. The progression of the epidemic is characterized by the reversal of socioeconomic gradients; tobacco use and low fruit and vegetable intake have become more prevalent among those from lower socioeconomic backgrounds. In addition, individuals from lower socioeconomic backgrounds frequently do not receive optimal therapy, leading to poorer outcomes. Countering the epidemic requires the development of strategies such as the formulation and effective implementation of evidencebased policy, reinforcement of health systems, and emphasis on prevention, early detection, and treatment with the use of both conventional and innovative techniques. Several ongoing community-based studies are testing these strategies.

show abstract

Section: Cvd Prevention and Treatment Strategiesmentioning

confidence: 99%

Cardiovascular Diseases in India

2016

View full text Add to dashboard Cite

show abstract

“…Independent data collection will be conducted by trained household surveyors based on previous well-established and acceptable methods [6,8-10,13]. Collection will occur on five occasions for each village – at baseline, at each interim time-interval ( i.e ., each ‘step,’ see Table 1), and at the end of follow-up.…”

Section: Methodsmentioning

confidence: 99%

“…In the setting of HIV/AIDS care, task-shifting has been shown to improve health outcomes and processes of care [12]. In India, there is some evidence that task shifting CVD risk assessment to non-physician health workers via a simple algorithm can increase the detection of CVD [13]. An example of front-line health workers in India is Accredited Social Health Activists (ASHAs), who are local female residents from the village.…”

Section: Introductionmentioning

confidence: 99%

A multifaceted strategy using mobile technology to assist rural primary healthcare doctors and frontline health workers in cardiovascular disease risk management: protocol for the SMARTHealth India cluster randomised controlled trial

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundBlood Pressure related disease affected 118 million people in India in the year 2000; this figure will double by 2025. Around one in four adults in rural India have hypertension, and of those, only a minority are accessing appropriate care. Health systems in India face substantial challenges to meet these gaps in care, and innovative solutions are needed.MethodsWe hypothesise that a multifaceted intervention involving capacity strengthening of primary healthcare doctors and non-physician healthcare workers through use of a mobile device-based clinical decision support system will result in improved blood pressure control for individuals at high risk of a cardiovascular disease event when compared with usual healthcare. This intervention will be implemented as a stepped wedge, cluster randomised controlled trial in 18 primary health centres and 54 villages in rural Andhra Pradesh involving adults aged ≥40 years at high cardiovascular disease event risk (approximately 15,000 people). Cardiovascular disease event risk will be calculated based on World Health Organisation/International Society of Hypertension’s region-specific risk charts. Cluster randomisation will occur at the level of the primary health centres. Outcome analyses will be conducted blinded to intervention allocation.Expected outcomesThe primary study outcome is the difference in the proportion of people meeting guideline-recommended blood pressure targets in the intervention period vs. the control period. Secondary outcomes include mean reduction in blood pressure levels; change in other cardiovascular disease risk factors, including body mass index, current smoking, reported healthy eating habits, and reported physical activity levels; self-reported use of blood pressure and other cardiovascular medicines; quality of life (using the EQ-5D); and cardiovascular disease events (using hospitalisation data). Trial outcomes will be accompanied by detailed process and economic evaluations.SignificanceThe findings are likely to inform policy on a scalable strategy to overcome entrenched inequities in access to effective healthcare for under-served populations in low and middle income country settings.Trial registrationClinical Trial Registry India CTRI/2013/06/003753.

show abstract

“…Yet, whereas NPHWs can make as valid decisions as physicians regarding prevention and treatment pathways for CVD, 25 in many countries there are legislative barriers to the use of NPHWs (only physicians may be allowed to prescribe drugs in many countries, or patients expect that decisions on treatments made by physicians are superior).These barriers can be overcome through changes in legislation that allow NPHWs the ability to prescribe a small range of simple, effective, and safe drugs; to educate patients to accept NPHWs; and to combine these with strategies to improve adherence. Furthermore, NPHWs can visit patients at their homes (as is done for immunizations and tuberculosis and malaria control in some countries), thereby improving access of patients to health care and simultaneously reducing their out-of-pocket costs related to traveling long distances to see physicians.…”

Section: Article See P 1483 and P 1493mentioning

confidence: 99%

Documenting the Global Burden of Cardiovascular Disease

Yusuf

2014

Circulation

View full text Add to dashboard Cite

The Rural Andhra Pradesh Cardiovascular Prevention Study (RAPCAPS)

Cited by 77 publications

References 21 publications

Cardiovascular Diseases in India

Cardiovascular Diseases in India

A multifaceted strategy using mobile technology to assist rural primary healthcare doctors and frontline health workers in cardiovascular disease risk management: protocol for the SMARTHealth India cluster randomised controlled trial

Documenting the Global Burden of Cardiovascular Disease

Contact Info

Product

Resources

About