No abstract

Background There is a need to evaluate & implement cost-effective strategies to improve adherence to treatments in Coronary Heart Disease (CHD). There are no studies from Low Middle Income Countries (LMICs) evaluating trained Community Health Worker (CHW) based interventions for the secondary prevention of CHD. Methods We designed a hospital-based, open randomized trial of CHW based interventions versus standard care. Patients after an Acute Coronary Syndrome (ACS) were randomized to an intervention group (a CHW based intervention package, comprising education tools to enhance self-care and adherence, and regular follow-up by the CHW) or to standard care for 12 months during which study outcomes were recorded. The CHWs were trained over a period of 6 months. The primary outcome measure was medication adherence. The secondary outcomes were differences in adherence to lifestyle modification, physiological parameters (BP, body weight, BMI, heart rate, lipids) and major adverse cardiovascular events. Results We recruited 806 patients stabilized after an ACS from 14 hospitals in 13 Indian cities. The mean age was 56.4 (+/−11.32) and 17.2% were females. A high prevalence of risk factors -hypertension (43.4%), diabetes (31.9%), tobacco consumption (35.4%) and inadequate physical activity (70.5%) were documented. A little over half had ST elevation myocardial infarction (STEMI, 53.7%) and 46.3% had non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Conclusion The CHW interventions and training for SPREAD have been developed and adapted for local use. The results and experience of this study will be important to counter the burden of Cardiovascular Diseases (CVD) in LMICs.

No abstract

No abstract

No abstract