Exploring New Models for Cardiovascular Risk Reduction: The Heart Outcomes Prevention and Evaluation 4 (HOPE 4) Canada Pilot Study

Abstract

Background There is a gap between evidence and practice in the management of cardiovascular (CV) risk. Previous research indicated benefits from community-based, multi-faceted interventions to screen, diagnose, and manage CV risk in people with hypertension. Methods The Heart Outcomes Prevention and Evaluation 4 Canada pilot study (HOPE 4) was a quasi-experimental pre–post interventional study, involving one community each in Hamilton, Ontario and Surrey, British Columbia, Canada. Individuals aged ≥50 years with newly diagnosed or poorly controlled hypertension were included. The intervention was comprised of: (i) simplified diagnostic/treatment algorithms implemented by community health workers (firefighters in British Columbia and community health workers in Ontario) guided by decision support and counselling software; (ii) recommendations for evidence-based CV medications and lifestyle modifications; and (iii) support from family/friends to promote healthy behaviours. The intervention was developed as part of the international Heart Outcomes Prevention and Evaluation 4 Canada pilot study trial and adapted to the Canadian context. The primary outcome was the change in Framingham Risk Score 10-year CV disease risk estimate between baseline and 6 months. Results Between 2016 and 2017, a total of 193 participants were screened, with 37 enrolled in Surrey, and 19 in Hamilton. Mean age was 69 years (standard deviation 11), with 54% female, 27% diabetic, and 73% with a history of hypertension. An 82% follow-up level had been obtained at 6 months. Compared to baseline, there were significant improvements in the Framingham Risk Score 10-year risk estimate (30.6% vs 24.7%, P < 0.01), and systolic blood pressure (153.1 vs 136.7 mm Hg, P < 0.01). No significant changes in lipids or healthy behaviours were noted. Conclusions A comprehensive approach to health care delivery, using a community-based intervention with community health workers, supported by mobile-health technologies, has the potential to significantly reduce cardiovascular risk, but further evaluation is warranted.

Adherence to Cardiovascular Prevention Guidelines in an Academic Centre

“…The most obvious intervention at this level is to broaden the availability and use of multidisciplinary care in the outpatient setting, based on both our findings and guideline recommendations. 23 In addition, the randomized Effectiveness of Brazilian Intervention to Increase Evidence Usage (BRIDGE) Cardiovascular Prevention study 20 showed that a combination of case management, feedback reports, and educational materials for physicians and patients leads to increased use of evidence-based therapies. Several current technologies also have capability to provide real-time checklists and decision aids to providers and aid in the proper documentation of important prevention interventions.…”

“…Despite the availability of well-developed cardiovascular prevention guidelines, a number of barriers appear to limit their application in clinical practice. 23 However, although guideline adherence has been evaluated among general practitioners, 17 , 18 , 19 , 20 , 21 data are limited regarding guideline adherence among cardiologists. 24 Better definition of treatment gaps among specialists may shed important light on the nature of these barriers, to help improve real-world prevention and lead to specific interventions.…”

Refining a primary care shared decision-making aid for lifestyle change: a mixed-methods study

“…Routine consultations in primary care settings present an important opportunity to target lifestyle behaviours [1].Current UK guidelines recommend that we identify patients who are not sufficiently active and offer support to encourage behaviour change [2]. Lifestyle advice can be of particular benefit to patients with established cardiovascular disease risk factors, including physical inactivity, poor diet and obesity [3][4][5][6]. However, these factors are infrequently discussed with patients in routine practice [7].…”

Introduction to the special focus on the development of the autonomic nervous system

“…For example, hypertension is an inappropriately high blood pressure at rest and/or during activity and may be brought on by dysfunction of the ANS favoring the sympathetic rather than the parasympathetic response (Mancia & Grassi, 2014). Strategies to rebalance this response include the use of drugs, meditation, and even direct neuronal stimulation using focused lasers (Colombo et al, 2021) in addition to major lifestyle changes to diet, activity, and ameliorating stresses (Schwalm et al, 2021). We know, probably from personal experience, that major lifestyle changes are difficult and take time.…”