Abstract 13411: Effect of Multilevel, Nurse-Led, Mobile Health Enhanced Intervention on Cardiovascular Disease Risk Reduction Among Patients With Uncontrolled Hypertension in Ghana: Evidence From the ADHINCRA Study

Abstract

Introduction: Although cardiovascular disease (CVD) accounts for over two-thirds of premature mortality in Africa, risk assessments to guide preventive interventions for atherosclerotic CVD are rarely performed in many clinical settings. Objective: To investigate the impact of Nurse-led intervention on ASCVD risk reduction in adults with uncontrolled hypertension in Kumasi, Ghana enrolled in the ADHINCRA study. Methods: Using a cluster randomized controlled pilot trial design, four hospitals were randomized to the intervention arm and enhanced usual care (UC) arm. Two hundred and forty (240) participants were randomized to intervention (120 participants) or enhanced usual care (120 participants). We estimated the 10-year ASCVD risks for adults older than 40 years using Pooled Cohort Equations (PCE). We employed a mixed-effect linear regression model to predict the mean risk score as a function of the treatment group. ASCVD was first modeled as a continuous outcome, then categorized according to the ACC/AHA cut points: low (<5%), Borderline (5%-<7.5%), Intermediate (≥7.5% <20%), and high-risk (≥20%). Result: The mean age (SD) was 53 ± 9.7 years; 117 men [49%]. The mean [SE] ASCVD scores for the intervention and Enhanced Usual group (EUC) arms at baseline were 14.1% (0.93) and 15.4% (1.03) respectively. At Month 12, the mean ASCVD score was 13.8% (0.77) in the intervention group and 15.2% (0.98) in the Enhanced usual group. Using the AAC/AHA risk categorization, 24% of patients in the intervention and 27% in the EUC were in the high-risk category. Relatively, ASCVD risk was 1.27% (95 CI -2.36, -0.17; P = .023) lower in the intervention group compared to the EUC arm at month 12 ( Figure 1 ). Conclusion: The Nurse-Led Multilevel Mobile Health Intervention led to a reduction in ASCVD risk, however, the reduction was not sustained after month 6, a more robust RCT is required to examine intervention sustainability in Ghana.