Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP) - PubMed (original) (raw)
Randomized Controlled Trial
doi: 10.1136/bmj.d442.
Larry W Chambers, Lisa Dolovich, J Michael Paterson, Tina Karwalajtys, Tracy Gierman, Barbara Farrell, Beatrice McDonough, Lehana Thabane, Karen Tu, Brandon Zagorski, Ron Goeree, Cheryl A Levitt, William Hogg, Stephanie Laryea, Megan Ann Carter, Dana Cross, Rolf J Sabaldt
Affiliations
- PMID: 21300712
- PMCID: PMC3034422
- DOI: 10.1136/bmj.d442
Randomized Controlled Trial
Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)
Janusz Kaczorowski et al. BMJ. 2011.
Abstract
Objective: To evaluate the effectiveness of the community based Cardiovascular Health Awareness Program (CHAP) on morbidity from cardiovascular disease.
Design: Community cluster randomised trial.
Setting: 39 mid-sized communities in Ontario, Canada, stratified by location and population size.
Participants: Community dwelling residents aged 65 years or over, family physicians, pharmacists, volunteers, community nurses, and local lead organisations.
Intervention: Communities were randomised to receive CHAP (n = 20) or no intervention (n = 19). In CHAP communities, residents aged 65 or over were invited to attend volunteer run cardiovascular risk assessment and education sessions held in community based pharmacies over a 10 week period; automated blood pressure readings and self reported risk factor data were collected and shared with participants and their family physicians and pharmacists.
Main outcome measure: Composite of hospital admissions for acute myocardial infarction, stroke, and congestive heart failure among all community residents aged 65 and over in the year before compared with the year after implementation of CHAP.
Results: All 20 intervention communities successfully implemented CHAP. A total of 1265 three hour long sessions were held in 129/145 (89%) pharmacies during the 10 week programme. 15,889 unique participants had a total of 27,358 cardiovascular assessments with the assistance of 577 peer volunteers. After adjustment for hospital admission rates in the year before the intervention, CHAP was associated with a 9% relative reduction in the composite end point (rate ratio 0.91, 95% confidence interval 0.86 to 0.97; P = 0.002) or 3.02 fewer annual hospital admissions for cardiovascular disease per 1000 people aged 65 and over. Statistically significant reductions favouring the intervention communities were seen in hospital admissions for acute myocardial infarction (rate ratio 0.87, 0.79 to 0.97; P = 0.008) and congestive heart failure (0.90, 0.81 to 0.99; P = 0.029) but not for stroke (0.99, 0.88 to 1.12; P = 0.89).
Conclusions: A collaborative, multi-pronged, community based health promotion and prevention programme targeted at older adults can reduce cardiovascular morbidity at the population level. Trial registration Current controlled trials ISRCTN50550004.
Conflict of interest statement
Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi\_disclosure.pdf (available on request from the corresponding author) and declare that none of the authors has financial interests that may be relevant to the submitted work
Figures
Profile of CHAP trial, including main components of intervention. CHAP=Cardiovascular Health Awareness Program
Comment in
- Prevention: CV risk assessment and education in community pharmacies work!
Mearns BM. Mearns BM. Nat Rev Cardiol. 2011 Apr;8(4):182. doi: 10.1038/nrcardio.2011.34. Nat Rev Cardiol. 2011. PMID: 21553719 No abstract available. - ACP Journal Club. The Cardiovascular Health Awareness Program reduced CV hospitalizations but not mortality in older adults.
Elley CR, Kerse N. Elley CR, et al. Ann Intern Med. 2011 Jun 21;154(12):JC6-3. doi: 10.7326/0003-4819-154-12-201106210-02003. Ann Intern Med. 2011. PMID: 21690581 No abstract available. - Czy można systemowo doprowadzić dopoprawy stanu zdrowia sercowo−naczyniowegona poziomie populacyjnym?Randomizowane badanie CHAP.
Bednarek A. Bednarek A. Kardiol Pol. 2011;69(7):745-6; discussion 747-8. Kardiol Pol. 2011. PMID: 21769806 Polish. No abstract available.
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