Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)
Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP)
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DOI：
10.1136/bmj.d442
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发表时间：
2011-02-07
影响因子：
105.7
通讯作者：
Sabaldt, Rolf J.
中科院分区：
文献类型：
--
作者：
Kaczorowski, Janusz;Chambers, Larry W.;Sabaldt, Rolf J.
目的评价以社区为基础的心血管健康意识项目（CHAP）对心血管疾病发病率的影响。设计社区随机分组试验。设置加拿大安大略省的39个中型社区，按位置和人口规模分层。参与者年龄在65岁或以上的社区居民、家庭医生、药剂师、志愿者、社区护士和当地的领导机构。干预社区随机分为接受CHAP （n=20）和不进行干预（n=19）两组。在CHAP社区，65岁或以上的居民被邀请参加志愿者在社区药房举办的心血管风险评估和教育会议，为期10周；自动血压读数和自我报告的风险因素数据被收集起来，并与参与者及其家庭医生和药剂师分享。主要结果测量与实施CHAP后一年相比，所有65岁及以上社区居民在实施CHAP前一年因急性心肌梗死、中风和充血性心力衰竭住院的综合情况。结果所有20个干预社区都成功实施了CHAP。在为期10周的计划中，129/145（89%）家药店共举行了1265次3小时的会议。15889名独特的参与者在577名同伴志愿者的帮助下共进行了27358次心血管评估。在对干预前一年的住院率进行调整后，CHAP与复合终点相对减少9%（比率为0.91,95%可信区间为0.86至0.97；P=0.002）或每1000名65岁及以上人群心血管疾病年住院率减少3.02相关。在急性心肌梗死（比率比0.87,0.79 ~ 0.97，P=0.008）和充血性心力衰竭（比率比0.90,0.81 ~ 0.99，P=0.029）的住院人数中，干预社区有统计学意义上的显著减少，但在中风（比率比0.99,0.88 ~ 1.12，P=0.89）的住院人数中没有显著减少。结论以老年人为目标，开展合作、多管齐下、以社区为基础的健康促进和预防项目，可降低人群心血管发病率。
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.