Abstract 19401: Reduction of Cardiovascular Risk - Community Based Program in Resource Limited Set Up
Introduction: Lack of resources limits treatments options for heart disease in Nepal. Early detection and management of risk factors through community participation may help prevent cardiovascular events and control of risk factors.
Hypothesis: To activate community participation to create awareness, detect and manage risk factors for cardiovascular disease, diabetes, hypertension and proteinuria that ultimately expected to prevent CVD deaths.
Methods: A network of community volunteer, primary health center or equivalent, district hospital and tertiary care center was established to educate, screen and intervene for hypertension, diabetes, cardiovascular risk factors. WHO/ISH Risk prediction charts were used to calculate cardiovascular risk. The person known to have cardiovascular disease risk received locally available cheaper medications. A mechanism was developed to follow-up patients in primary or equivalent health centre. The subjects were closely monitored by community volunteers to pursue follow-up and adherence to prescribed treatment. Cardiovascular risk reduction, control of glycemia and blood pressure and smoking cessation was assesed.
Results: A total of 25,000 people from eastern Nepal were evaluated. 5years. History of stroke, heart attack or angina and smoking were elicited in 0.56%, 1.21% and 0.56% and 23.5%. Hypertension, obesity, diabetes were found in 22%, 5.3% and 8.4% of the screened population, respectively. 40% of hypertensive and 48% of diabetics patients were newly detected during the screening. Estimated GFR (MDRD) <60 ml/min/1.73m2 was documented in 10.6%. Two or more cardiovascular risk factors were present in 29.6% of the screened population. 4100 subjects positive at screening entered an intervention program by combining lifestyle modifications and pharmacological management with cheap drugs. At 3 years, glycemic (HbA1c <7%) and blood pressure control (<140/90 mmHg) was achieved in 63% and 73%, respectively. The prevalence of participants with a predicted 10 year cardiovascular risk of 10% or more was 28% at baseline and decreased to 17% after 3 years.
Conclusions: Volunteer based community participatory model allow to reduced cardiovascular risk in resource limited set up.
Author Disclosures: S.K. Sharma: None. A. Ghimire: None. B. Koirala: None.
- © 2016 by American Heart Association, Inc.