IMPROVING CARDIOVASCULAR HEALTH AT THE POPULATION LEVEL: A 39 COMMUNITY CLUSTER-RANDOMISED TRIAL OF THE CARDIOVASCULAR HEALTH AWARENESS PROGRAM (CHAP): PS.3.03

Abstract

Objective: Cardiovascular disease (CVD) is a major cause of death and disability. Effective population-based strategies to reduce CVD morbidity and mortality are needed. We conducted a community cluster-randomized trial to evaluate the effectiveness of a pharmacy-based Cardiovascular Health Awareness Program (CHAP) on cardiovascular disease morbidity. Design and Method: Thirty-nine mid-sized communities in Ontario, Canada were stratified by location and population size and were randomized to receive CHAP (n = 20) or no intervention (n = 19). In CHAP communities, residents 65 years of age or older 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 session participants and their family physicians and pharmacists. The primary trial endpoint was a composite of hospital admissions for acute myocardial infarction, stroke and congestive heart failure among all community residents aged 65 years and older. Analysis was by intention to treat. The study was registered at controlled-trials.com, number ISRCTN50550004. Results: All 20 intervention communities successfully implemented CHAP. A total of 1 265 3-hour long sessions were held in 90% (129/145) of pharmacies during the 10-week campaign. A total of 27 358 CVD assessments were performed on 15 889 unique participants with the assistance of 577 peer-volunteers. Adjusting for hospital admission rates in the year prior to intervention, CHAP was associated with a 9% relative reduction in our composite endpoint (rate ratio 0.91 [95% CI 0.86–0.97], p = 0.002). There were statistically significant reductions favouring the intervention communities in hospital admissions for acute myocardial infarction (rate ratio 0.87 [95% CI 0.79 – 0.97], p = 0.008) and congestive heart failure (rate ratio 0.90 [95% CI 0.81 – 0.99], p = 0.029), but not for stroke (rate ratio 0.99 [95% CI 0.88–1.12], p = 0.89). Conclusions: A collaborative, multipronged community-based health promotion and prevention program targeted at older adults can reduce cardiovascular morbidity at the population level.