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Global health activities in developing countries to combat non-communicable chronic Cardiovascular and Pulmonary diseases - Centers of Excellence (CoE) PDF Print

Under the Global Health Initiative of National Heart Lung and Blood Institute, National Institutes of Health, USA, PHFI has received a competitively awarded grant to establish a ‘Centre of Excellence (COE) in Prevention and Control of Cardio metabolic Diseases (CMD) in South Asia’ for applied research and training. The CoE-CARRS will serve as one of 11 Collaborating Centers of Excellence to counter chronic non-communicable diseases in developing countries. The collaborating institutions in the COE are PHFI, EMORY University, AIIMS, Madras Diabetes Research Foundation and Aga Khan University. The COE will primarily focus on establishing a robust applied science base through two complementary activities: (a) development and implementation of a model sentinel surveillance scheme capturing population-based CMD risk factor data; and (b) A randomized controlled translation trial to evaluate implementation of low-cost, multi-factorial, multi-faceted, innovative, scalable and sustainable delivery improvement strategies for CVD risk reduction. A summary of the two studies are given below:

CARRS : Surveillance Study

CARRS - Surveillance study is a cohort-modeled, community based surveillance plan for capturing cardio-metabolic diseases and broad ranged data on its risk factors in the urban population of South Asia in the cities of Delhi, Chennai and Karachi. The study will estimate the following parameters:

  • Prevalence of CMD and their distal and intermediate risk factors
  • Anthropometric Changes - Weight, Waist Circumference , Skinfold Thickness, Body Fat
  • Development of new-onset intermediate risk factors – Hypertension, Diabetes Mellitus, Dyslipidaemia
  • Incident morbidity – Stroke, MI, CHF, Chronic Stable Angina, Chronic Kidney Disease
  • Complications – Peripheral vascular diseases, Retinopathy, Nephropathy, Neuropathy, Amputation
  • Health service utilization and costs - Hospitalization, Outpatient use
  • Mortality - All cause, CMD-specific

A total of 12,000 permanently-residing urban dwellers (4,000 participants each in the three cities) above the age of 20 years will be sampled at baseline. The primary study design for the surveillance model is cross-sectional. A cohort study design will be used to follow-up the participants for three years subsequently. The baseline survey commenced in October 2010 and is currently recruiting the participants.

CARRS Translation Trial : Developing and Testing Integrated, Multi-factorial Cardiovascular Disease Risk Reduction Strategies in South Asia (CARRS Translation Trial)

Cardiovascular diseases (CVD) are currently the leading cause of death globally and Asian Indians, as a group, are projected to account for between 40-60% of global CVD burden within the next 10-15 years. Robust evidence has demonstrated the efficacy of risk factor control and preventive processes of care in reducing CVD events and mortality. Since CVD risk factors do not occur in isolation, the greatest gains in CVD prevention have been seen when earlier, intensive, target-driven, multi-factorial interventions have been applied together. However, implementation of evidence-based recommendations and achieving control of even individual risk factors (HbA1c, BP, or blood lipid targets) is sub-optimal, globally. Moreover, quality improvement schemes (involving coordinated and decision-supported care) are untested in South Asia, a region with a population at extraordinarily high cardio-metabolic risk.

We aim to test the effectiveness and sustainability of a comprehensive cardiovascular disease (CVD) risk reduction intervention, using clinical decision-support software and non-physician care coordinators, in Type 2 diabetes patients attending out-patient clinics in South Asia, compared to standard care.

The study is a multi-site, individually randomized, controlled translation trial of a cardiovascular risk reduction intervention in 1,120 Type 2 diabetes patients attending 8 established out-patient clinics in South Asia, for a mean follow-up of 30 months. Half of the patients will be randomized to the intervention, which utilizes a combination of health care management strategies:

(1) a web-enhanced decision-support software that serves to store patient health records; provide patient management advice; and prompt and remind care providers and participants of recommended care processes; and (2) a non-physician care coordinator to facilitate patient self-management and provider adherence to evidence-based management guidelines, which includes regular 3-monthly visits for patient evaluation. The care coordinator is the main person who interacts with the decision-support software, collecting and inputting all intervention data into the decision support software and providing management prompts to the study physician. The control group will receive the standard care existing at the clinical site. All study physicians will have equal access to the evidence-based management guidelines.

The trial will be conducted in two phases. In January 2011, Phase 1 (Vanguard Phase) of the trial will begin at 3 clinic sites to assess intervention feasibility (recruitment and retention, continuity of care), establish procedures, and engage in team-building. Upon successful completion of this first phase within 6 months, the other 5 sites will join the study as Phase 2 of the trial.

Principal Investigator: D. Prabhakaran
Co – Principal Investigator:
Project Duration: 2009 – 2014
Last Modified : January 27, 2011, 11:31 am